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Study reports Double Balloon Endoscopy useful for diagnosis and treatment of obscure GI bleeding
Date:10/31/2008

c yield of 54.2 percent. However, DBE when examined in the context of symptomatic indication, gave a diagnosis for bleeding in 100 percent of patients with overt-ongoing bleeding, 48.4 percent of patients with overt-previous bleeding, and 42.1 percent of patients with occult bleeding. The difference in diagnostic yields between the overt-ongoing group and the two other groups was statistically significant (P < .005).

54.2 percent of patients had a potential source of small intestinal bleeding identified, while 45.8 percent of patients had a negative DBE. The most common sources of bleeding were ulcers (21/108 patients) and tumors (19/108). There were no serious complications encountered. Follow-up data was available for 93 patients. Eight patients (7.4 percent), four from the positive DBE and four from the negative DBE group, had recurrent bleeding during the mean follow-up period of 28.5 months. Sensitivity, specificity, positive, and negative predictive values of DBE in the diagnoses of small intestinal lesions in patients with obscure GI bleeding were 92.7 percent, 96.4 percent, 98.1 percent, and 87.1 percent, respectively.

The authors show that identification of a bleeding source in obscure GI bleeding is most likely when DBE is performed during or soon after a bleeding episode; similar conclusions have been reached on studies of CE. The authors propose that patients with obscure overt-ongoing bleeding ought to be examined by a DBE first for concurrent diagnosis and endoscopic hemostasis. In cases of overt-previous or occult obscure GI bleeding, the priority should be given to the less invasive CE. Future prospective studies should consider clinical outcomes such as cost-effectiveness, length of hospitalization, and the amount of blood transfusion, to clarify the role of CE and DBE in the diagnosis and management of obscure GI bleeding with overt-ongoing bleeding.


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Contact: Anne Brownsey
abrownsey@asge.org
630-570-5635
American Society for Gastrointestinal Endoscopy
Source:Eurekalert

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