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Study identifies double-balloon enteroscopy as cost-effective approach for obscure GI bleeding
Date:11/24/2008

University Hospital, Calif. "We performed a decision analysis to explore the optimal management strategy for patients with obscure GI bleeding and found that among the current options for diagnosis and management of small bowel lesions, an initial double-balloon enteroscopy would be a cost-effective approach because of its ability to identify and treat lesions during the initial small bowel examination."

Patients and Methods

The study did not use an actual patient, but rather a model that played out different possible treatment options. The base-case (hypothetical) patient was a 50-year-old man with a six-month history of recurrent melena (stools stained black by blood pigment or dark blood products) and associated iron deficiency. The patient had a prior normal upper endoscopic examination, colonoscopy, and small bowel x-ray series. The patient was considered to be a candidate for a CE, as well as endoscopic or surgical therapy, for presumed small-bowel sources of the bleeding.

A cost-effectiveness analysis is a quantitative method used to evaluate the outcomes and costs of interventions designed to improve health. Researchers in this study used decision analysis software to create a decision flow chart to compare no therapy (reference arm) to five other treatment options: (1) push enteroscopy, (2) intraoperative enteroscopy (done in an operating room requiring a formal surgery), (3) angiography, (4) initial anterograde DBE, followed by a retrograde DBE if the patient had ongoing bleeding, and (5) small bowel CE followed by a DBE guided by the CE findings. Patients in the CE arm would only proceed to a DBE if they had persistent obscure bleeding after the CE examination. Patients with normal CE examinations and ongoing GI hemorrhage would undergo an initial anterograde DBE, with the assumption that a lesion might have been missed on the prior CE examination. The patients in the no-therapy arm would not undergo any endoscopic intervent
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Contact: Anne Brownsey
abrownsey@asge.org
630-570-5635
American Society for Gastrointestinal Endoscopy
Source:Eurekalert

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