Push enteroscopy for gastrointestinal bleeding: diagnostic yield and long-term follow-up.
OBJECTIVE
Little is known about the long-term course of patients explored by push enteroscopy for gastrointestinal bleeding of obscure origin. This study aimed to determine the diagnostic yield and the therapeutic impact of enteroscopy, the rate of rebleeding and predictive factors of rebleeding in these patients.


METHODS
One hundred nineteen patients underwent push enteroscopy for overt bleeding (N=66) or anemia (N=53).


RESULTS
Enteroscopy was positive in 42% of patients (colon 17%, stomach 13%, small bowel 12%) and diagnosed arteriovenous malformations in two-thirds of patients. Twenty-five additional diagnoses were established during the 2-month follow-up. Treatment was definitive in 13% of patients, without recurrent bleeding. Rebleeding occurred in 45% of patients, and was more frequent when a lesion was visualized (73% vs 28% after 5 years, P=0.02). In multivariate analysis, a lesion visualized by enteroscopy was the only independent predictive factor.


CONCLUSIONS
Enteroscopy is not a high-performance diagnostic tool for obscure gastrointestinal bleeding and enables definitive treatment in less than 15% of patients.
Romelaer
Charlotte
C
Service d'Hépato-Gastroentérologie, CHU de Nantes, Hôtel-Dieu, 44093 Nantes Cedex.
Le Rhun
Marc
M
Beaugerie
Laurent
L
Gournay
Jérôme
J
Masliah
Claude
C
Coron
Emmanuel
E
Galmiche
Jean-Paul
JP
Bruley Des Varannes
Stanislas
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003663:Decision Trees; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D013997:Time Factors