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Emergency double‐balloon enteroscopy combined with real‐time viewing of capsule endoscopy: A feasible combined approach in acute overt‐obscure gastrointestinal bleeding?
Author(s) -
PérezCuadrado Robles Enrique,
Bebia Conesa Paloma,
Esteban Delgado Pilar,
Zamora Nava Luis E.,
Martínez Andrés Blanca,
Rodrigo Agudo Jose L.,
López Higueras Antonio,
López Martin Aurelio,
Latorre Rafael,
Soria Federico,
PérezCuadrado Martínez Enrique
Publication year - 2015
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12384
Subject(s) - medicine , capsule endoscopy , enteroscopy , double balloon enteroscopy , emergency department , hemostasis , endoscopy , gastroenterology , balloon , radiology , surgery , psychiatry
Background and Aim There are few data concerning emergency double‐balloon enteroscopy ( DBE ) and its usefulness in the management of severe acute obscure gastrointestinal bleeding ( OGIB ). The aim of this retrospective study was to evaluate emergency DBE and capsule endoscopy ( CE ) in patients with overt OGIB , analyzing the feasibility of this combined approach. Methods Emergency DBE in patients with overt OGIB was defined as performance within 24 h of symptom onset. We reported 27 patients (16 men, mean age: 64.6 ± 17.9 years) with overt severe bleeding who underwent 29 emergency DBE (22 anterograde, 7 retrograde). Of 27 patients, 16 (59.3%) underwent CE with real time ( RT ) viewing. Results Patients were diagnosed with the following: D ieulafoy's lesion ( DL ; n = 11, 40.7%), angioectasia ( n = 7, 25.9%), tumors ( n = 4, 14.8%), diverticulum ( n = 3, 11.1%), ulcers ( n = 2, 7.4%). We diagnosed 23 lesions amenable to endoscopic hemostasis and successfully treated 21 of them (77.8%). DL detection rate was statistically higher in the emergency DBE group than in OGIB patients with DBE done 24 h after symptom onset (40.7% vs 0.9%, respectively, P < 0.001). Combined approach with RT viewing by CE correctly modified DBE management in four patients (25%). Conclusions Emergency DBE is feasible, safe and effective in acute OGIB and may avoid major surgery, diagnosing and successfully treating most patients. Combined approach with RT viewing by CE is especially useful to identify recurrent bleeding vascular lesions such as DL that may be easily misdiagnosed by non‐emergency DBE .