Diagnosis and treatment of obscure GI bleeding at double balloon endoscopy.
BACKGROUND
Double balloon endoscopy (DBE) and videocapsule endoscopy (VCE) have been useful in managing obscure GI bleeding (OGIB).


OBJECTIVE
This study evaluated the usefulness of DBE for diagnosis, treatment, and prognosis of OGIB and compared diagnostic yield between DBE and VCE in Japan.


METHODS
Detection rates of abnormalities and diagnostic yields between VCE and DBE were compared in 74 patients at 5 centers. Of 244 patients who underwent DBE at Nagoya University Hospital, 130 (53%) with OGIB were enrolled for investigation of therapeutic procedures.


METHODS
Seven Japanese medical centers.


METHODS
Of 1034 patients who underwent DBE between September 2000 and December 2005 at 7 medical centers, 479 (46%) with OGIB were enrolled.


RESULTS
Overall diagnostic yield of DBE for OGIB was 277 of 479 (58%). In patients with overt-ongoing bleeding, overt-previous bleeding of sporadic type, overt-previous bleeding of first attack only, occult bleeding with continuous positive fecal occult blood test (FOBT), or occult bleeding with 1 positive FOBT with iron deficiency anemia, diagnostic yield was 24 of 31 (77%), 179 of 310 (58%), 34 of 72 (47%), 24 of 35 (71%), and 56 of 93 (60%), respectively. Regarding positive findings in 277 patients, ulcers or erosions (53%) were the most frequent, followed by angiodysplasia (23%), tumors or polyps (22%), and diverticula (4%). Diagnoses in these patients were as follows: chronic inflammatory diseases (24%), vascular diseases (24%), tumor or polyps (21%), drug or radiation injury (7%), other small-bowel diseases (7%), upper GI diseases (9%), colorectal diseases (9%), and biliary disease (0.4%). Small-bowel diseases were confirmed in 226 patients (47%). Comparison of overall detection rate of abnormalities in the small bowel between VCE (65%) and DBE (53%) was not significantly different, nor was that of overall diagnostic yield between VCE (50%) and DBE (53%). Eight acute pancreatitis and 4 perforation episodes occurred with no mortalities at DBE. Of 130 patients at Nagoya University Hospital, 78 (60%) were diagnosed with small-bowel diseases and underwent treatments as follows: medication or observation only (n = 30), enteroscopic therapies (electrocoagulation in 21, clipping in 4, and polypectomy in 3), and surgery (n = 22). Small-bowel vascular diseases were more prone to rebleeding than small-bowel nonvascular diseases in patients without surgical treatment at a median follow-up of 423 days.


CONCLUSIONS
DBE was relatively safe and useful for diagnosis and treatment of OGIB. A spectrum of small-bowel diseases presenting with OGIB in Japan may be distinct from that in the Western world.
Ohmiya
Naoki
N
Department of Gastroenterology, Nagoya University Graduate School of Medicine, Japan.
Yano
Tomonori
T
Yamamoto
Hironori
H
Arakawa
Daigo
D
Nakamura
Masanao
M
Honda
Wataru
W
Itoh
Akihiro
A
Hirooka
Yoshiki
Y
Niwa
Yasumasa
Y
Maeda
Osamu
O
Ando
Takafumi
T
Yao
Tsuneyoshi
T
Matsui
Toshiyuki
T
Iida
Mitsuo
M
Tanaka
Shinji
S
Chiba
Tsutomu
T
Sakamoto
Choitsu
C
Sugano
Kentaro
K
Goto
Hidemi
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053705:Capsule Endoscopes; D002908:Chronic Disease; D003937:Diagnosis, Differential; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000628:therapy; D007421:Intestine, Small; D007564:Japan; D008297:Male; D008875:Middle Aged; D009780:Occult Blood