title: Antegrade double balloon enteroscopy for continued obscure gastrointestinal bleeding following push enteroscopy: is there a role?
abstract: BACKGROUND
  The benefit of double balloon endoscopy (DBE) over push enteroscopy (PE) for the proximal small bowel in patients with obscure gastrointestinal bleeding remains unclear.
  
  
  OBJECTIVE
  To quantify the benefit of DBE if PE fails to benefit patients with obscure gastrointestinal bleeding.
  
  
  METHODS
  This retrospective DBE database review between July 2004 and April 2008 was conducted at a tertiary university hospital in Australia. Thirty-three patients with obscure gastrointestinal bleeding who had undergone PE for proximal small bowel lesions were identified from a DBE database of 280 patients. Mean age was 68.6 (range 30-91) years, and 17 were men. In group A (n = 15) the target lesion was not reached by PE, and in group B (n = 18) an abnormality was found by PE (angioectasia in 17 and red spots in 1) but the patient had ongoing bleeding. Mean follow-up for the cohort was 19.2 (range 5-39) months. DBE interventions were performed as appropriate.
  
  
  RESULTS
  An abnormality was found at DBE in 28/33 (85%) patients. DBE found an abnormality in 12/15 (80%) in group A and 16/18 (89%) in group B. Endoscopic intervention was performed in 23/33 patients (70%). In 27/33 (82%) patients a clinical benefit was seen following DBE. Six patients (18%) had no clinical benefit from DBE.
  
  
  CONCLUSIONS
  In patients with obscure gastrointestinal bleeding and proximal small bowel lesions who fail to benefit from PE, DBE offers a very high benefit in finding and treating lesions with good long-term outcomes.
authors.affiliation: AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Suite 604, 35 Spring St Bondi Junction, Sydney, NSW 2022, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Chettiar
authors.forename: W S
authors.initials: WS
authors.lastname: Selby
authors.forename: A J
authors.initials: AJ
authors.lastname: Kaffes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome