title: Double balloon enteroscopy detects small bowel mass lesions missed by capsule endoscopy.
abstract: BACKGROUND
  Small bowel mass lesions (SBML) are a relatively common cause of obscure gastrointestinal bleeding (OGIB). Their detection has been limited by the inability to endoscopically examine the entire small intestine. This has changed with the introduction of capsule endoscopy (CE) and double balloon enteroscopy (DBE) into clinical practice.
  
  
  OBJECTIVE
  To evaluate the detection of SBML by DBE and CE in patients with OGIB who were found to have SBML by DBE and underwent both procedures.
  
  
  METHODS
  A retrospective review of a prospectively collected database of all patients undergoing DBE for OGIB at seven North American tertiary centers was performed. Those patients who were found to have SBML as a cause of their OGIB were further analyzed.
  
  
  RESULTS
  During an 18 month period, 183 patients underwent DBE for OGIB. A small bowel mass lesion was identified in 18 patients. Of these, 15 patients had prior CE. Capsule endoscopy identified the mass lesion in five patients; fresh luminal blood with no underlying lesion in seven patients, and non-specific erythema in three patients. Capsule endoscopy failed to identify all four cases of primary small bowel adenocarcinoma.
  
  
  CONCLUSIONS
  Double balloon enteroscopy detects small bowel mass lesions responsible for OGIB that are missed by CE. Additional endoscopic evaluation of the small bowel by DBE or intraoperative enteroscopy should be performed in patients with ongoing OGIB and negative or non-specific findings on CE.
authors.affiliation: The University of Chicago, Chicago, IL, USA. andrew.ross@vmmc.org
authors.forename: Andrew
authors.initials: A
authors.lastname: Ross
authors.forename: Shahab
authors.initials: S
authors.lastname: Mehdizadeh
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tokar
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Leighton
authors.forename: Ahmad
authors.initials: A
authors.lastname: Kamal
authors.forename: Ann
authors.initials: A
authors.lastname: Chen
authors.forename: Drew
authors.initials: D
authors.lastname: Schembre
authors.forename: Gary
authors.initials: G
authors.lastname: Chen
authors.forename: Kenneth
authors.initials: K
authors.lastname: Binmoeller
authors.forename: Richard
authors.initials: R
authors.lastname: Kozarek
authors.forename: Irving
authors.initials: I
authors.lastname: Waxman
authors.forename: Charles
authors.initials: C
authors.lastname: Dye
authors.forename: Lauren
authors.initials: L
authors.lastname: Gerson
authors.forename: M Edwyn
authors.initials: ME
authors.lastname: Harrison
authors.forename: Oleh
authors.initials: O
authors.lastname: Haluszka
authors.forename: Simon
authors.initials: S
authors.lastname: Lo
authors.forename: Carol
authors.initials: C
authors.lastname: Semrad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053704:Capsule Endoscopy; D003951:Diagnostic Errors / Q000517:prevention & control*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007414:Intestinal Neoplasms / Q000150:complications / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D014481:United States