Obscure gastrointestinal bleeding

Thalidomide: Gastrointestinal Bleeding

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Wolters Kluwer Health. Off-Label DrugFacts is a practitioner-oriented resource for information about specific FDA-unapproved drug uses. This new guide to the literature will enable the health care professional/clinician to quickly identify published studies on off-label uses and to determine if a specific use is rational in a patient care scenario. The most relevant data are provided in tabular form, so the reader can easily identify the scope of information available. A summary of the data—including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations—precedes each table of published studies. References direct the reader to the full literature for more comprehensive information prior to patient care decisions. Direct questions or comments regarding “Off-Label Drug Uses” to hospitalpharmacy@drugfacts.com .

Clinically significant small-bowel pathology identified by double-balloon enteroscopy but missed by capsule endoscopy

BACKGROUND

Capsule endoscopy (CE) is increasingly being used to investigate the small bowel for various indications, including obscure GI bleeding (OGB). However, false negatives have been described. Double-balloon enteroscopy (DBE) is a new endoscopic technique developed to potentially view the entire small intestine while allowing therapeutic options to be carried out when appropriate.

OBJECTIVE

We described 4 patients with small-bowel pathology missed on CE but detected by DBE.

DESIGN

Descriptive retrospective study. All patients underwent CE followed by DBE.

SETTING

Single-center tertiary referral hospital.

PATIENTS

Four patients were included. Three patients had OGB that required blood transfusions. One patient with celiac disease, compliant on a strict gluten-free diet for 5 months, presented with persistent weight loss and abdominal pain.

INTERVENTIONS

DBE followed by surgical exploration and resection of small-bowel pathology.

MAIN OUTCOME MEASUREMENTS

Successful identification of pathology missed by CE. Definitive treatment of small-bowel pathology by surgical resection.

RESULTS

CE did not identify the small-bowel pathology in all 4 patients. The 3 patients with OGB had small-bowel masses found by DBE. Two of these were GI stromal tumors and one was an adenocarcinoma. The patient with celiac disease had a malignant ulcer, confirmed to be a lymphoma after surgical resection.

LIMITATIONS

Retrospective study and small sample size.

CONCLUSIONS

CE and DBE are complementary investigations. If there is a high index of suspicion of small-bowel pathology despite a negative CE, DBE should be performed.