Double-balloon endoscopy useful for obscure GI bleeding diagnosis, treatment

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Researchers have found double-balloon endoscopy (DBE) to be efficacious in the diagnosis of obscure gastrointestinal (GI) bleeding and have a therapeutic impact on the majority of patients, according to a study in the October issue of GIE: Gastrointestinal Endoscopy.

Balloon-assisted enteroscopy technique is a new method that advances the scope through the small intestine by inflating and deflating balloons, and pleats the small bowel over a tube, allowing for diagnosis and treatment of small intestinal disorders.  

Researchers examined 108 patients at the Nippon Medical School, Tokyo, Japan, from July 2003 to February 2007 who had been referred for evaluation of obscure GI bleeding. Obscure GI bleeding was defined as overt GI bleeding or anemia in combination with stool test positive for blood of unknown cause despite negative upper and lower endoscopy.  

Patients were classified into three groups before a DBE was performed: patients seen with active bleeding were classified as the overt-ongoing group (13 patients); patients with previous episodes though not active bleeding, were the overt-previous group (76 patients); and patients with positive fecal occult blood and a decrease in Hb level more than 2 g/dL comprised the occult group (19 patients).

According to the findings, DBE demonstrated a diagnostic yield of 54.2 percent. However, DBE 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, the authors noted.

Study lead author Shu Tanaka, MD, Nippon Medical School, said that the study “showed that the sensitivity of DBE was 92.7 percent in the diagnosis of small intestinal lesions in patients with obscure GI bleeding and overall diagnostic yields were similar to those of capsule endoscopy [CE].”

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 researchers proposed that patients with obscure overt-ongoing bleeding ought to be examined by a DBE first for concurrent diagnosis and endoscopic hemostasis.

Tanaka and colleagues concluded that 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.