Diagnostic and therapeutic yields of urgent balloon-assisted enteroscopy in overt obscure gastrointestinal bleeding. Issue 11 (November 2018) - Rodrigues, Jaime P.
Abstract : Background and aims: Balloon-assisted enteroscopy (BAE) is one of the diagnostic and therapeutic procedures in the algorithm for the evaluation of overt obscure gastrointestinal bleeding (OGIB). There is currently no consensus regarding the role of urgent BAE in overt OGIB. The aims of this study were to compare the diagnostic and therapeutic yields of urgent and nonurgent BAE in patients with overt OGIB. Patients and methods: We conducted a retrospective, single-center study that included patients who underwent BAE for overt OGIB between January 2010 and December 2017. Urgent BAE was defined as an enteroscopy performed within 72 h of clinical presentation. Demographic, clinical, laboratory, and technical data were reviewed and the diagnostic and therapeutic yields evaluated and compared. Results: Seventy BAEs were performed in 57 patients with overt OGIB [29 (50.9%) females, mean age: 68.0±11.1 years]. The diagnostic yield of urgent BAE was significantly higher than nonurgent BAE (84.5 vs. 50.0%, P <0.01). The most common diagnosis were angiodysplasias (30%), tumors (15.7%), erosions/ulcers (4.3%), and diverticula (4.3%). Endoscopic therapy was more frequently performed in urgent BAE patients (57.7 vs. 31.8%, P =0.03). The most commonly used endoscopic therapies were argon plasma coagulation (30.0%), hemostatic clips (5.7%), epinephrine injection (5.7%), and polypectomy (2.9%). In terms of urgent BAE, the diagnostic yield was similar when enteroscopy was performed at less than or equal to 24, 48, or 72 h ( P >0.05), but the therapeutic yield was higher the earlier the enteroscopy was performed (100, 76.9, and 57.7% at ⩽24, ⩽48, and ⩽72 h respectively; P =0.03). Conclusion: The diagnostic and therapeutic impact of BAE was higher in an urgent setting. These data support an important role for urgent BAE in overt OGIB.