Clinical impact of push enteroscopy in patients with gastrointestinal bleeding of unknown origin.
OBJECTIVE
Despite the frequent use of push enteroscopy (PE), little is known of its clinical impact. The aim of this study was to evaluate the impact of PE on diagnostic and therapeutic management of patients with gastrointestinal bleeding of unknown origin.


METHODS
Seventy-five consecutive patients (mean age, 56 y) referred for PE were included in this 1-year prospective study. Indications for PE were overt bleeding in 46 patients (61%) and iron-deficiency anemia in 29 patients (39%). Before the procedure, the prescribing physicians were asked to fill out a questionnaire listing the theoretical patient management plan (diagnostic procedures and/or treatment) as if PE were not available. One month after PE, the same physicians were asked about: (1) diagnostic procedures performed after PE, (2) the final diagnosis, and (3) their opinion of the usefulness of PE in clinical management. The clinical impact of PE on diagnostic and/or therapeutic management was assessed by 3 study physicians.


RESULTS
Responses to the 2 questionnaires were obtained for all patients. The diagnostic yield of PE was 32% (24 of 75). The clinical impact of PE (changes in diagnostic and/or therapeutic management) was 55% (n = 41). PE was perceived as helpful by the prescribing physicians in 55% of cases. PE tended to influence patient management more in cases of overt bleeding than in cases of occult bleeding (63% vs. 41%; P = 0.06).


CONCLUSIONS
PE influenced the clinical management of more than half the patients with GI bleeding of unknown origin, and was particularly useful in patients with overt bleeding.
Department of Hepato-Gastroenterology, Hôpital Européen Georges Pompidou, Paris, France.
Alexis
A
Bezet
Emmanuel
E
Cuillerier
Bruno
B
Landi
Philippe
P
Marteau
Christophe
C
Cellier
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000209:etiology* / Q000628:therapy; D001165:Arteriovenous Malformations / Q000150:complications / Q000175:diagnosis; D001291:Attitude of Health Personnel; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005602:France; D005767:Gastrointestinal Diseases / Q000150:complications / Q000175:diagnosis; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy; D041981:Gastrointestinal Tract / Q000098:blood supply; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014741:Video Recording