Push enteroscopy alters management in a majority of patients with obscure gastrointestinal bleeding.
BACKGROUND
Although enteroscopy has been increasingly used to investigate occult or obscure bleeding, little is known about its impact on patient management. The aim of the present paper was to evaluate both the diagnostic yield and the impact of push enteroscopy on the management of patients referred to a tertiary Australian institution.


METHODS
Data were collected prospectively in all patients undergoing push enteroscopy at Royal Adelaide Hospital. Fifty-five patients were investigated for obscure gastrointestinal (GI) bleeding (25 women, mean age 65.6 years), the cause of which remained unknown despite previous gastroscopy and colonoscopy. The patients were divided into two groups: occult-obscure (anemia without macroscopic blood loss) and overt-obscure (macroscopic bleeding). Findings at enteroscopy, therapeutic procedures, and complications were recorded. Patients were followed to establish the impact of the procedure on subsequent management and clinical outcome.


RESULTS
Enteroscopy demonstrated a potential site of bleeding in 38 patients (69%), and 38% of lesions found were within the reach of the gastroscope. The most common lesions were small intestinal angiodysplasia. Seventy-five percent of patients with positive findings had alterations to their management. After subsequent treatment, 62% were no longer anemic and there was a significant reduction in rebleeding (P < 0.05) and transfusion requirements (P < 0.05) compared to patients with negative findings. The procedure was well tolerated and complications were rare.


CONCLUSIONS
Enteroscopy has a positive impact on patient management and clinical outcome in a majority of patients with obscure gastrointestinal bleeding.
Nguyen
Nam Q
NQ
Department of Gastroenterology, Hepatology and General Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Rayner
Christopher K
CK
Schoeman
Mark N
MN
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology / Q000628:therapy; D004066:Digestive System Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D015203:Reproducibility of Results; D016896:Treatment Outcome