title: Assessment of multi-modality evaluations of obscure gastrointestinal bleeding.
abstract: OBJECTIVE
  To determine the frequency of bleeding source detection in patients with obscure gastrointestinal bleeding (OGIB) who underwent double balloon enteroscopy (DBE) after pre-procedure imaging [multiphase computed tomography enterography (MPCTE), video capsule endoscopy (VCE), or both] and assess the impact of imaging on DBE diagnostic yield.
  
  
  METHODS
  Retrospective cohort study using a prospectively maintained database of all adult patients presenting with OGIB who underwent DBE from September 1st, 2002 to June 30th, 2013 at a single tertiary center.
  
  
  RESULTS
  Four hundred and ninety five patients (52% females; median age 68 years) underwent DBE for OGIB. AVCE and/or MPCTE performed within 1 year prior to DBE (in 441 patients) increased the diagnostic yield of DBE (67.1% with preceding imagingvs59.5% without). Using DBE as the gold standard, VCE and MPCTE had a diagnostic yield of 72.7% and 32.5% respectively. There were no increased odds of finding a bleeding site at DBE compared to VCE (OR = 1.3,P= 0.150). There were increased odds of finding a bleeding site at DBE compared to MPCTE (OR = 5.9,P< 0.001). In inpatients with overt OGIB, diagnostic yield of DBE was not affected by preceding imaging.
  
  
  CONCLUSIONS
  DBE is a safe and well-tolerated procedure for the diagnosis and treatment of OGIB, with a diagnostic yield that may be increased after obtaining a preceding VCE or MPCTE. However, inpatients with active ongoing bleeding may benefit from proceeding directly to antegrade DBE.
authors.affiliation: Ryan Law, Jithinraj E Varayil, Louis M WongKeeSong, Jeffrey Alexander, Elizabeth Rajan, Stephanie Hansel, Brenda Becker, David H Bruining, Nayantara Coelho-Prabhu, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States.
authors.forename: Ryan
authors.initials: R
authors.lastname: Law
authors.affiliation: Ryan Law, Jithinraj E Varayil, Louis M WongKeeSong, Jeffrey Alexander, Elizabeth Rajan, Stephanie Hansel, Brenda Becker, David H Bruining, Nayantara Coelho-Prabhu, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States.
authors.forename: Jithinraj E
authors.initials: JE
authors.lastname: Varayil
authors.affiliation: Ryan Law, Jithinraj E Varayil, Louis M WongKeeSong, Jeffrey Alexander, Elizabeth Rajan, Stephanie Hansel, Brenda Becker, David H Bruining, Nayantara Coelho-Prabhu, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States.
authors.forename: Louis M
authors.initials: LM
authors.lastname: WongKeeSong
authors.affiliation: Ryan Law, Jithinraj E Varayil, Louis M WongKeeSong, Jeffrey Alexander, Elizabeth Rajan, Stephanie Hansel, Brenda Becker, David H Bruining, Nayantara Coelho-Prabhu, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States.
authors.forename: Jeff
authors.initials: J
authors.lastname: Fidler
authors.affiliation: Ryan Law, Jithinraj E Varayil, Louis M WongKeeSong, Jeffrey Alexander, Elizabeth Rajan, Stephanie Hansel, Brenda Becker, David H Bruining, Nayantara Coelho-Prabhu, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States.
authors.forename: Joel G
authors.initials: JG
authors.lastname: Fletcher
authors.affiliation: Ryan Law, Jithinraj E Varayil, Louis M WongKeeSong, Jeffrey Alexander, Elizabeth Rajan, Stephanie Hansel, Brenda Becker, David H Bruining, Nayantara Coelho-Prabhu, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States.
authors.forename: John
authors.initials: J
authors.lastname: Barlow
authors.affiliation: Ryan Law, Jithinraj E Varayil, Louis M WongKeeSong, Jeffrey Alexander, Elizabeth Rajan, Stephanie Hansel, Brenda Becker, David H Bruining, Nayantara Coelho-Prabhu, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Alexander
authors.affiliation: Ryan Law, Jithinraj E Varayil, Louis M WongKeeSong, Jeffrey Alexander, Elizabeth Rajan, Stephanie Hansel, Brenda Becker, David H Bruining, Nayantara Coelho-Prabhu, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rajan
authors.affiliation: Ryan Law, Jithinraj E Varayil, Louis M WongKeeSong, Jeffrey Alexander, Elizabeth Rajan, Stephanie Hansel, Brenda Becker, David H Bruining, Nayantara Coelho-Prabhu, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Hansel
authors.affiliation: Ryan Law, Jithinraj E Varayil, Louis M WongKeeSong, Jeffrey Alexander, Elizabeth Rajan, Stephanie Hansel, Brenda Becker, David H Bruining, Nayantara Coelho-Prabhu, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States.
authors.forename: Brenda
authors.initials: B
authors.lastname: Becker
authors.affiliation: Ryan Law, Jithinraj E Varayil, Louis M WongKeeSong, Jeffrey Alexander, Elizabeth Rajan, Stephanie Hansel, Brenda Becker, David H Bruining, Nayantara Coelho-Prabhu, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Larson
authors.affiliation: Ryan Law, Jithinraj E Varayil, Louis M WongKeeSong, Jeffrey Alexander, Elizabeth Rajan, Stephanie Hansel, Brenda Becker, David H Bruining, Nayantara Coelho-Prabhu, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States.
authors.forename: Felicity T
authors.initials: FT
authors.lastname: Enders
authors.affiliation: Ryan Law, Jithinraj E Varayil, Louis M WongKeeSong, Jeffrey Alexander, Elizabeth Rajan, Stephanie Hansel, Brenda Becker, David H Bruining, Nayantara Coelho-Prabhu, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States.
authors.forename: David H
authors.initials: DH
authors.lastname: Bruining
authors.affiliation: Ryan Law, Jithinraj E Varayil, Louis M WongKeeSong, Jeffrey Alexander, Elizabeth Rajan, Stephanie Hansel, Brenda Becker, David H Bruining, Nayantara Coelho-Prabhu, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States.
authors.forename: Nayantara
authors.initials: N
authors.lastname: Coelho-Prabhu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053704:Capsule Endoscopy; D058582:Double-Balloon Enteroscopy; D020776:Endoscopes, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D015203:Reproducibility of Results; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Computed tomography enterography; Double balloon enteroscopy; Obscure gastrointestinal bleeding; Video capsule enteroscopy