title: Emergency double-balloon enteroscopy combined with real-time viewing of capsule endoscopy: a feasible combined approach in acute overt-obscure gastrointestinal bleeding?
abstract: OBJECTIVE
  There are few data concerning emergency double-balloon enteroscopy (DBE) and its usefulness in the management of severe acute obscure gastrointestinal bleeding (OGIB). The aim of this retrospective study was to evaluate emergency DBE and capsule endoscopy (CE) in patients with overt OGIB, analyzing the feasibility of this combined approach.
  
  
  METHODS
  Emergency DBE in patients with overt OGIB was defined as performance within 24 h of symptom onset. We reported 27 patients (16 men, mean age: 64.6 ± 17.9 years) with overt severe bleeding who underwent 29 emergency DBE (22 anterograde, 7 retrograde). Of 27 patients, 16 (59.3%) underwent CE with real time (RT) viewing.
  
  
  RESULTS
  Patients were diagnosed with the following: Dieulafoy's lesion (DL; n = 11, 40.7%), angioectasia (n = 7, 25.9%), tumors (n = 4, 14.8%), diverticulum (n = 3, 11.1%), ulcers (n = 2, 7.4%). We diagnosed 23 lesions amenable to endoscopic hemostasis and successfully treated 21 of them (77.8%). DL detection rate was statistically higher in the emergency DBE group than in OGIB patients with DBE done 24 h after symptom onset (40.7% vs 0.9%, respectively, P < 0.001). Combined approach with RT viewing by CE correctly modified DBE management in four patients (25%).
  
  
  CONCLUSIONS
  Emergency DBE is feasible, safe and effective in acute OGIB and may avoid major surgery, diagnosing and successfully treating most patients. Combined approach with RT viewing by CE is especially useful to identify recurrent bleeding vascular lesions such as DL that may be easily misdiagnosed by non-emergency DBE.
authors.affiliation: Small Bowel Unit, Department of Gastroenterology, Morales Meseguer Hospital, Murcia, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Pérez-Cuadrado Robles
authors.forename: Paloma
authors.initials: P
authors.lastname: Bebia Conesa
authors.forename: Pilar
authors.initials: P
authors.lastname: Esteban Delgado
authors.forename: Luis E
authors.initials: LE
authors.lastname: Zamora Nava
authors.forename: Blanca
authors.initials: B
authors.lastname: Martínez Andrés
authors.forename: Jose L
authors.initials: JL
authors.lastname: Rodrigo Agudo
authors.forename: Antonio
authors.initials: A
authors.lastname: López Higueras
authors.forename: Aurelio
authors.initials: A
authors.lastname: López Martin
authors.forename: Rafael
authors.initials: R
authors.lastname: Latorre
authors.forename: Federico
authors.initials: F
authors.lastname: Soria
authors.forename: Enrique
authors.initials: E
authors.lastname: Pérez-Cuadrado Martínez
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D053704:Capsule Endoscopy / Q000379:methods*; D003131:Combined Modality Therapy; D058582:Double-Balloon Enteroscopy / Q000379:methods*; D004630:Emergencies; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Dieulafoy's lesion; capsule endoscopy (CE); emergency double-balloon enteroscopy (DBE); obscure gastrointestinal bleeding (OGIB); real time