title: Long-term outcome of patients treated with double balloon enteroscopy for small bowel vascular lesions.
abstract: OBJECTIVE
  Early rebleeding rate after endoscopic therapy with double balloon enteroscopy (DBE) of hemorrhagic small bowel vascular lesions (SBVL) varies between 10 and 50%. In recent reports, long-term follow-up of patients have been described but rebleeding risk factors are still not well established. The aim of the current study was to identify long-term treatment success rate and rebleeding risk factors after DBE therapy in a large cohort.
  
  
  METHODS
  We conducted a single-center, retrospective cohort study in a large French tertiary-referral center between January 2004 and December 2007.
  
  
  RESULTS
  Among 261 patients presenting with obscure gastrointestinal bleeding (OGIB), SBVL was present in 133 patients and was treated successfully in 129 (97%) using mainly argon plasma coagulation. Ninety-eight patients were followed up for a mean period of 22.6±13.9 months (range 1-52). Rebleeding rate was 46% (45/98 patients) at 36 months. On multivariate analysis, the total number of observed lesions (hazard ratio (HR): 1.15, 95% confidence interval (CI): 1.06-1.25, P=0.001) and the presence of a valvular and/or arrhythmic cardiac disease (HR: 2.50, 95% CI: 1.29-4.87, P=0.007) were significantly associated with the risk of rebleeding. Complication rate of therapeutic DBE was 2.3% with no mortality.
  
  
  CONCLUSIONS
  Endoscopic therapy using DBE for SBVL in patients with recurrent OGIB allows a long-term remission in more than half of the patients. Independent rebleeding risk factors after a first endoscopic therapy are an increased number of SBVL and an associated valvular/arrhythmic heart disease.
authors.affiliation: Université Paris Descartes, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Samaha
authors.forename: G
authors.initials: G
authors.lastname: Rahmi
authors.forename: B
authors.initials: B
authors.lastname: Landi
authors.forename: C
authors.initials: C
authors.lastname: Lorenceau-Savale
authors.forename: G
authors.initials: G
authors.lastname: Malamut
authors.forename: J-M
authors.initials: JM
authors.lastname: Canard
authors.forename: F
authors.initials: F
authors.lastname: Bloch
authors.forename: R
authors.initials: R
authors.lastname: Jian
authors.forename: G
authors.initials: G
authors.lastname: Chatellier
authors.forename: C
authors.initials: C
authors.lastname: Cellier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058582:Double-Balloon Enteroscopy; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D007410:Intestinal Diseases / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome