Role of double balloon enteroscopy in obscure gastrointestinal bleeding

Evaluation and outcomes of patients with obscure gastrointestinal bleeding

Obscure gastrointestinal bleeding (OGIB) is defined as recurrent or persistent bleeding or presence of iron deficiency anaemia after evaluation with a negative bidirectional endoscopy. OGIB accounts for 5% of gastrointestinal bleeding and presents a diagnostic challenge. Current modalities available for the investigation of OGIB include capsule endoscopy, balloon assisted enteroscopy, spiral enteroscopy and computed tomography enterography. These modalities overcome the limitations of previous techniques. Following a negative bidirectional endoscopy, capsule endoscopy and double balloon enteroscopy remain the cornerstone of investigation in OGIB given their high diagnostic yield. Long-term outcome data in patients with OGIB is limited, but is most promising for capsule endoscopy. This article reviews the current literature and provides an overview of the clinical evaluation of patients with OGIB, available diagnostic and therapeutic modalities and long-term clinical outcomes.

Small intestinal vascular malformation bleeding: diagnosis by double-balloon enteroscopy combined with abdominal contrast-enhanced CT examination

Aim

The purpose of this study was to explore the value of double-balloon enteroscopy combined with abdominal vascular-enhanced CT examination for the diagnosis of intestinal vascular malformation bleeding, to explore a simple and effective method for the diagnosis of small intestinal vascular malformation bleeding.

Methods

Ten patients with intestinal bleeding were first examined with double-balloon enteroscopy. If active bleeding considered as vascular malformation was observed, the patient underwent abdominal vascular-enhanced CT examination. If no active bleeding was observed with double-balloon enteroscopy, the patient also underwent abdominal vascular-enhanced CT examination. When intestinal vascular malformation bleeding was diagnosed with double-balloon enteroscopy and/or abdominal vascular-enhanced CT examination, the patient underwent surgical operation and vascular malformation was confirmed with pathologic diagnosis.

Results

In ten patients who underwent double-balloon enteroscopy examination, active intestinal bleeding was observed in seven patients and no active bleeding was observed in three patients. All ten patients underwent abdominal vascular-enhanced CT examination and vascular malformation was detected in all the patients with confirmation by pathologic diagnosis.

Conclusion

Double-balloon enteroscopy combined with abdominal vascular enhanced CT examination is a simple and effective method for the diagnosis of intestinal vascular malformation bleeding.