title: Double-Balloon Enteroscopy-detected Lipid Islets in the Small Bowel are Strong Predictors of Cardiovascular Disease when associated with Angiectasia and Bleeding.
abstract: OBJECTIVE
  Double-balloon enteroscopy (DBE) is a sensitive and safe procedure for the detection and treatment of mid-gastrointestinal bleeding (MGIB). It combines the possibility of a panenteroscopy with the immediate chance for intervention. This study evaluates the yield of DBE for the detection and treatment of MGIB in an unselected patient cohort.
  
  
  METHODS
  In a five-year period a total of 119 DBEs were carried out on 62 patients due to MGIB. Inclusion criteria were hematochezia, melena, anemia, positive hemoccult-test and iron deficiency. All pre-existing diseases or comorbidities were evaluated. Two main statistical methodologies were used in data analysis: descriptive statistics to describe the basic features of our data and Fisher's exact test for comparisons of proportions.
  
  
  RESULTS
  The diagnostic yield was 69% (pathological findings in 43/62 patients) and the main diagnoses in all DBE-procedures were angiodysplasia (22%, 26/119 DBE), followed by lipid islets (18%, 21/119 DBE). In all patients with lipid islets this diagnosis was significantly connected with cardiovascular diseases. The combination of lipid islets and a relevant bleeding source appeared in 79% of the 19 patients with these findings. Of these, 53% had to be treated due to the bleeding event. The overall therapeutic intervention rate was 58%. Serious complications such as perforation or pancreatitis did not occur.
  
  
  CONCLUSIONS
  Double-balloon enteroscopy as the gold standard for small bowel investigation in MGIB confirmed its high diagnostic yield in an unselected cohort of patients. A new strong combination of lipid islets with cardiovascular disease was revealed, with a high incidence of angiectasia bleeding. This combination should be evaluated in more detail as a new risk factor for MGIB, and should be regarded in this population when therapeutic anticoagulation is needed.
authors.affiliation: Department of Medicine 1, Gastroenterology and Interventional Endoscopy, University of Erlangen-Nuremberg, Erlangen, Germany. heinz.albrecht@uk-erlangen.de.
authors.forename: Heinz
authors.initials: H
authors.lastname: Albrecht
authors.affiliation: Department of Medicine 1, Gastroenterology and Interventional Endoscopy, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Wolfgang H
authors.initials: WH
authors.lastname: Hagel
authors.affiliation: Department of Medicine 1, Gastroenterology and Interventional Endoscopy, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Alexander F
authors.initials: AF
authors.lastname: Hagel
authors.affiliation: Department of Medicine 1, Gastroenterology and Interventional Endoscopy, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Markus F
authors.initials: MF
authors.lastname: Neurath
authors.affiliation: Department of Medicine 1, Gastroenterology and Interventional Endoscopy, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Raithel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016888:Angiodysplasia / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D002318:Cardiovascular Diseases / Q000150:complications* / Q000175:diagnosis; D058582:Double-Balloon Enteroscopy / Q000009:adverse effects; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000628:therapy; D016558:Hemostasis, Endoscopic; D006801:Humans; D007421:Intestine, Small / Q000737:chemistry* / Q000473:pathology; D066292:Lipid Droplets; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult