BIRMINGHAM, AL — Small-bowel evaluation through video-capsule endoscopy (VCE) or double-balloon enteroscopy (DBE) is often necessary to determine the cause of overt obscure gastrointestinal bleeding (OOGIB).
The condition is defined as continued bleeding with unknown source despite esophagogastroduodenoscopy (EGD) and colonoscopy evaluation.
Researchers from the University of Alabama and the Birmingham/Atlanta VA Geriatric Research, Education, & Clinical Center recently assessed the timing of DBE in hospitalized OOGIB patients, focusing on diagnostic yield, therapeutic yield, and GI rebleeding.
To do that, the study team along with German researchers performed a retrospective review of DBEs performed at a tertiary-medical center between November 2012 and December 2020. Results were reported in JGH Open.1
First admission for OOGIB undergoing DBE was the inclusion criteria, while those without previous EGD or colonoscopy were excluded.
The 154 patients included two groups: DBE performed within 72 hours of OOGIB (emergent), 62, and beyond 72 hours of OOGIB (nonemergent), 92. The propensity-score-matched sample consisted of 112 patients, with 56 patients each in the emergent and nonemergent groups.
“Univariate and multivariable logistic regression analysis showed a significant association between VCE and emergent DBE and diagnostic and therapeutic yield (P < 0.05),” the researchers reported. “Emergent DBE patients had increased GI bleed-free survival compared to those in the nonemergent group (P = 0.009).”
The study said its data demonstrated that emergent DBE during inpatient OOGIB can impact the overall diagnostic yield, therapeutic yield and GI rebleeding post DBE.
Background information in the articles advised that obscure gastrointestinal (GI) bleeding accounts for up to 5-10% of GI bleeding.
“OOGIB is often suspected to originate in the small bowel, with common culprit lesions consisting of Dieulafoy’s lesions, neoplasias, angioectasias/angiodysplasias, ulceration, and polyps,” the authors wrote. They add that “diagnostic approaches in situations of OOGIB include video capsule endoscopy (VCE), radiographic imaging in the form of computed tomography (CT) scans, push enteroscopy, or deeper endoscopic procedures including balloon enteroscopy.”
The study pointed out that discussion has recently focused on the timing of device‐assisted enteroscopy from the onset of initial bleed for OOGIB, “with most data demonstrating the benefits of performing the procedure as soon as possible to increase the overall diagnostic and therapeutic yield. During inpatient admissions, prompt timing of DBE can be quite challenging, given the myriad hospital parameters and patient factors.”
- Aryan M, Venkata KVR, Colvin T, Daley L, Patel P, et. al. Early intervention with double balloon enteroscopy for higher yield for inpatient overt obscure gastrointestinal bleeding: A propensity matched analysis. JGH Open. 2023 Jul 17;7(7):509-515. doi: 10.1002/jgh3.12943. PMID: 37496818; PMCID: PMC10366483
