Obscure GI bleeding in the tropics: impact of introduction of double-balloon and capsule endoscopies on outcome.
BACKGROUND
Innovative but costly small-bowel enteroscopies, capsule endoscopy (CE), and double-balloon endoscopy (DBE) have revolutionized the management of obscure GI bleeding (OGIB).


OBJECTIVE
To measure the impact of these procedures on outcomes of OGIB in a resource-poor setting.


METHODS
Prospective cohort study and comparison with a historical cohort.


METHODS
Tertiary-care center in India.


METHODS
Fifty-three patients with OGIB, diagnosed by American Gastroenterological Association criteria.


METHODS
DBE and/or CE were performed. Patients were then offered specific treatment and/or hematinics.


METHODS
The etiology of OGIB in a tropical country and yield of DBE and/or CE. The number of investigations required, follow-up hemoglobin, rebleeds, and interventions/transfusions needed were compared between the present and historical cohort.


RESULTS
Mean age was 46.4 years with hemoglobin (mean +/- standard deviation) of 8.3 +/- 2.3 g/dL at evaluation. OGIB was overt in 33 and occult in 20. They underwent 173 investigations before referral. DBE and/or CE localized the source of bleeding in 43 (yield 81%). Angiodysplasias, tumors, Crohn's disease, intestinal tuberculosis, and hookworm infestation were predominant etiologies. Compared with the historical cohort, DBE and/or CE have reduced the number of investigations per patient, increased the yield of mid intestinal source of OGIB, and reduced the number of surgeries, especially emergency laparotomies. There was no significant alteration in the overall yield, mortality, and rebleeding rates.


CONCLUSIONS
Small cohort without economic analysis.


CONCLUSIONS
The demographic profile and etiological spectrum of OGIB in the tropics is different. DBE and/or CE have made a favorable impact on management.
Das
Kshaunish
K
Division of Gastroenterology, School of Digestive and Liver Diseases, IPGME&R, Kolkata, West Bengal, India. dockdas@gmail.com
Sarkar
Rajib
R
Dasgupta
Jayanta
J
Ray
Sukanta
S
Ghatak
Supriyo
S
Das
Kausik
K
Mridha
Asit R
AR
Dhali
Gopal K
GK
Chowdhury
A
A
D000328:Adult; D000368:Aged; D053704:Capsule Endoscopy / Q000379:methods*; D002404:Catheterization / Q000295:instrumentation*; D020776:Endoscopes, Gastrointestinal; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000628:therapy; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014329:Tropical Climate; D055815:Young Adult