Abstract and Introduction
Introduction: Although enteroscopy has been increasingly used to investigate occult or obscure bleeding, little is known about its impact on patient management. The aim of the present paper was to evaluate both the diagnostic yield and the impact of push enteroscopy on the management of patients referred to a tertiary Australian institution.
Methods: Data were collected prospectively in all patients undergoing push enteroscopy at Royal Adelaide Hospital. Fifty-five patients were investigated for obscure gastrointestinal (GI) bleeding (25 women, mean age 65.6 years), the cause of which remained unknown despite previous gastroscopy and colonoscopy. The patients were divided into two groups: occult-obscure (anemia without macroscopic blood loss) and overt-obscure (macroscopic bleeding). Findings at enteroscopy, therapeutic procedures, and complications were recorded. Patients were followed to establish the impact of the procedure on subsequent management and clinical outcome.
Results: Enteroscopy demonstrated a potential site of bleeding in 38 patients (69%), and 38% of lesions found were within the reach of the gastroscope. The most common lesions were small intestinal angiodysplasia. Seventy-five percent of patients with positive findings had alterations to their management. After subsequent treatment, 62% were no longer anemic and there was a significant reduction in rebleeding ( P < 0.05) and transfusion requirements ( P < 0.05) compared to patients with negative findings. The procedure was well tolerated and complications were rare.
Conclusion: Enteroscopy has a positive impact on patient management and clinical outcome in a majority of patients with obscure gastrointestinal bleeding.
Up to 5% of patients with recurrent gastrointestinal (GI) bleeding will remain undiagnosed by standard gastroscopy and colonoscopy. In these patients, the small intestine is often suspected as the potential site of bleeding.[1,2] During the past two decades push enteroscopy has become an important investigation in the evaluation of patients with obscure GI bleeding, with diagnostic yields varying from 38% to 80%.[211] However, studies on the impact of push enteroscopy on the clinical outcome of these patients are lacking. Two retrospective studies have suggested that push enteroscopy may influence management decisions in 40% of patients.[2,11] Another study demonstrated a reduction in transfusion requirements and an improvement in general well-being.[12] In an Australian study ( n = 11) using push enteroscopy, there was a reduction in monthly transfusion rate in the patients who had lesions found and treated on push enteroscopy.[13] There are currently no large Australian series evaluating the outcome of push enteroscopy in patients with obscure GI bleeding.
The present study aims to evaluate the diagnostic yield of push enteroscopy and its impact on the management of patients referred to a tertiary Australian institution with obscure bleeding from the GI tract.
J Gastroenterol Hepatol. 2005;20(5):716-721. © 2005 Blackwell Publishing
Cite this: Push Enteroscopy Alters Management in a Majority of Patients With Obscure Gastrointestinal Bleeding - Medscape - Mar 15, 2005.
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