Published online Jul 16, 2022. doi: 10.4253/wjge.v14.i7.434
Peer-review started: January 11, 2022
First decision: March 10, 2022
Revised: March 16, 2022
Accepted: June 3, 2022
Article in press: June 3, 2022
Published online: July 16, 2022
Obscure gastrointestinal (GI) bleeding is defined as persistent bleeding despite negative evaluation with both esophagogastroduodenoscopy and colonoscopy and is often secondary to small intestinal pathology. This form of GI bleeding has now become manageable with the introduction of single balloon enteroscopy or double balloon enteroscopy. Those with distorted anatomy may require thorough investigation of the upper GI tract during obscure GI bleeding, and balloon enteroscopy may be warranted.
Balloon enteroscopy can be warranted in instances of obscure GI bleeding in those with altered anatomy; however, literature remains limited on the overall diagnostic and therapeutic yields as well as the overall safety of these procedures in this patient population.
The primary aim of this systematic review was to assess the diagnostic and therapeutic efficacy of balloon enteroscopy for obscure GI bleeding in patients with surgically altered anatomy. The secondary aim was to investigate the safety of balloon enteroscopy in this patient population.
We performed an extensive literature search on PubMed, Google Scholar, Scopus, and Embase where relevant articles were carefully reviewed. Terms used for the search included “enteroscopy,” “obscure bleeding,” “gastrointestinal bleeding,” and “altered anatomy.” Further search with the Reference Citation Analysis database was conducted to ensure inclusion of the latest high impact articles. Prospective and retrospective reviews, case series, and case reports were all included. Data from each study that fit our inclusion criteria were extracted into an excel file in a systematic fashion. Statistical analysis in the form of descriptive statistics was reported from each study.
Following our literature search, 14 studies were included in our review. In total, there were 68 procedures performed with 61 unique patients that had undergone these procedures. From the available data in each study, there was an overall diagnostic yield of 48/59 (81%) and a therapeutic yield of 39/59 (66%). Five (7%) procedures were complicated by perforation.
Our systematic review shows that balloon enteroscopy can be implemented in obscure GI bleeding in those with altered anatomy. Diagnostic and therapeutic yields were as high as 83% and 64% respectively. Given the overall perforation of 7%, caution is warranted in such cases. Further literature is needed to expand upon our findings.
Balloon enteroscopy remains a viable option to investigate obscure GI bleeding in those with altered anatomy. Caution is warranted given the reported perforation rates; however, further studies are needed to add to the limited available literature.