title: Long-term outcome of patients with obscure gastrointestinal bleeding investigated by double-balloon endoscopy.
abstract: OBJECTIVE
  It is often difficult to determine the cause of obscure gastrointestinal bleeding (OGIB). We evaluated the diagnostic yield and long-term outcome of patients with OGIB by using double-balloon endoscopy (DBE).
  
  
  METHODS
  In this large, retrospective cohort study, DBE was performed in 200 consecutive patients with OGIB. Follow-up data were available from 151 patients for 29.7 months (range, 6-78 months), and clinical outcome was assessed.
  
  
  RESULTS
  DBE detected bleeding sources in 155 of 200 patients (77.5%). The most frequent source detected was small intestine ulcers/erosions (64 patients). Patients who underwent DBE within 1 month after the last episode of overt bleeding had a better yield of positive findings than those who did not (84%, 107/128 patients vs 57%, 24/42; P = .002). The overall rate of control of OGIB was 64% (97/151 patients). Patients with vascular lesions of the small intestine had a significantly lower rate of control of OGIB than those with other small intestine lesions (40%, 12/30 patients vs 74%, 52/70; P = .001). A requirement for a large transfusion before DBE (P = .012), multiple lesions (P = .010), and suspicious (not definite) lesions (P = .038) each significantly increased the likelihood of overt rebleeding in patients with vascular lesions of the small intestine.
  
  
  CONCLUSIONS
  DBE is useful for the diagnosis of patients with OGIB and should be performed as soon as possible after overt OGIB. Patients with vascular lesions of the small intestine should be followed with particular care.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shinozaki
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yano
authors.forename: Keijiro
authors.initials: K
authors.lastname: Sunada
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Miyata
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Arashiro
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sugano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult