Double-Balloon Enteroscopy following Capsule Endoscopy in the Management of Obscure Gastrointestinal Bleeding: Outcome of a Combined Approach
Autor: | Norman E. Marcon, Sarah Cho, Patarapong Kamalaporn, Paul Kortan, Maria Cirocco, Gary May, Nancy Basset, Gabor Kandel |
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Rok vydání: | 2008 |
Předmět: |
Adult
Male Enteroscopy medicine.medical_specialty Less invasive Capsule Endoscopy law.invention Cohort Studies Predictive Value of Tests Capsule endoscopy law Double-balloon enteroscopy medicine Humans lcsh:RC799-869 Aged Retrospective Studies Aged 80 and over medicine.diagnostic_test business.industry Gastroenterology General Medicine Balloon Occlusion Middle Aged Tissue sampling Combined approach Surgery Intestinal Diseases Treatment Outcome Female Original Article lcsh:Diseases of the digestive system. Gastroenterology Gastrointestinal Hemorrhage business Obscure gastrointestinal bleeding |
Zdroj: | Canadian Journal of Gastroenterology, Vol 22, Iss 5, Pp 491-495 (2008) |
ISSN: | 0835-7900 |
Popis: | BACKGROUND: There is no consensus on the relative accuracy of capsule endoscopy (CE) versus double-balloon enteroscopy (DBE) to investigate obscure gastrointestinal bleeding (GIB). CE is less invasive, but DBE more directly examines the small bowel, and allows tissue sampling plus therapeutic intervention.OBJECTIVES: To evaluate the yield and outcome of DBE following CE in patients with obscure GIB.METHODS: After DBE became readily available at the Centre for Therapeutic Endoscopy and Endoscopic Oncology (St Michael’s Hospital, Toronto, Ontario), all patients with obscure GIB seen from December 2002 to June 2007 were evaluated identically, first with CE, then with DBE (some with further interventions). Findings, adverse outcomes and interventions are reported.RESULTS: Fifty-one patients (25 women) with a mean (range) age of 64.1 years (34 to 83 years) are reported. Eight patients underwent DBE twice, for a total of 59 DBEs. Fourteen patients had overt GIB and the median (range) number of red blood cell unit transfusions was 10 (0 to 100). The positive findings for each type of lesion were compared in these 51 patients: angiodysplasia (CE 64.7% and DBE 61%, P=0.3), ulcers (CE 19.6% and DBE 18.6%, P=0.5), bleeding lesions (CE 43.1% and DBE 15.3%, P=0.0004) and mass (CE 10.2% and DBE 8.5%, P=0.5). DBE provided the advantage of therapeutic intervention: argon plasma coagulation (33 of 59 DBEs), clipping (two of 59), both argon plasma coagulation and clipping (three of 59), polypectomy (two of 59), tattooing (52 of 59) and biopsies (11 of 59). DBE detected lesions not seen by CE in 21 patients; lesions were treated in 18 patients. However, CE detected 31 lesions not seen by DBE. No major complications occurred with either examination.CONCLUSION: Overall detection rates for both techniques are similar. Each technique detected lesions not seen by the other. These data suggest that CE and DBE are complementary and that both evaluate obscure GIB more fully than either modality alone. |
Databáze: | OpenAIRE |
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