Less favorable clinical outcome after diagnostic and interventional double balloon enteroscopy in patients with suspected small-bowel bleeding?

BACKGROUND AND STUDY AIMS: Double balloon enteroscopy (DBE) is a new endoscopic technique that allows diagnosis and therapeutic interventions of small-bowel lesions. One of the main indications for DBE is suspected small-bowel bleeding (SSBB). Data about clinical outcome after DBE are limited. The aim of the present study was to prospectively assess the short-term clinical outcome of this procedure.

PATIENTS AND METHODS: Of all consecutive patients undergoing DBE for various indications, follow-up results in patients with SSBB were analyzed. Standardized questionnaires were used, including assessment of gastrointestinal symptoms, especially signs of gastrointestinal bleeding, blood transfusions, demand for re-intervention, and hospitalization.

RESULTS: Of a total of 180 DBEs performed in 124 patients during a 2-year period, SSBB was the indication in 84 patients (M/F = 46/38; mean age 63 years) who underwent a total of 111 DBEs. Of these patients 52 could be followed (mean follow-up 2 months, range 1-5 months). In this subgroup, positive findings were obtained in 30 (mostly angiodysplasia), with therapeutic interventions being performed in 18 of these patients. At follow-up, the rate of re-bleeding in patients who had undergone interventions (20%) was similar to that in patients who had not (18%).

CONCLUSION: In this pilot study, DBE did not seem to have a major effect on re-bleeding. Better patient selection or modification of therapeutic regimens appears to be necessary to better utilize DBE in SSBB.