Single‐balloon enteroscopy for managing obscure gastrointestinal bleeding: Results from a tertiary medical center in Taiwan. Issue 1 (31st March 2017) - Chen, Bao‐Chung
Summary: Backgrounds: Obscure gastrointestinal bleeding (OGIB) accounts for approximately 5‐10% of all gastrointestinal bleeding events, and its detection and treatment remain challenging. We aimed to investigate the performance, diagnostic yield, and outcome of single‐balloon enteroscopy (SBE) for OGIB in Taiwan. Patients and methods: The data for 81 OGIB patients who underwent SBE between September 2009 and February 2015 in a tertiary medical center in Taiwan were retrospectively analyzed. Results: A total of 81 OGIB patients underwent 132 SBE procedures. Anterograde and retrograde approaches were used for 52.3% and 47.7% of subjects, respectively. The overall diagnostic yield of SBE was 72.8%. The incidence of OGIB was higher in the proximal small intestine (the third and fourth parts of the duodenum and the jejunum) than in the distal small intestine (ileum) (58.3% vs. 36.6%), and the most common etiology was angiodysplasia (29.6%), followed by single ulcers (12.3%), and tumors (8.6%). Of the 59 patients with a positive finding on SBE, 26 (44.1%) patients with stigmata of hemorrhage underwent endoscopic hemostasis, including adrenaline injection, heater probe application, Argon plasma coagulation, and hemoclip placement. No hemorrhage, perforation, acute pancreatitis, or other serious complications occurred. OGIB recurred in 41.6% of patients in whom a source of OGIB was detected and 44.4% of patients with a negative finding after initial SBE. The rebleeding rate was higher in angiodysplasia than non‐angiodysplasia cases (55% vs. 32.1%, p = 0.113). After the SBE procedure, 57.6% of patients sustained no recurrent bleeding. Conclusions: Although SBE is a safe and reliable method for managing OGIB, recurrent bleeding is difficult to treat, especially rebleeding in patients with angiodysplasia or negative findings. Future research should aim to identify the risk factors for recurrent bleeding, increase the accuracy of detection, and reach a consensus on managing OGIB. Copyright © 2017, The Gastroenterological Society of Taiwan, The Digestive Endoscopy Society of Taiwan and Taiwan Association for the Study of the Liver.