Retrospective Study
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World J Gastrointest Endosc. Jun 16, 2014; 6(6): 248-253
Published online Jun 16, 2014. doi: 10.4253/wjge.v6.i6.248
Predictors of double balloon endoscopy outcomes in the evaluation of gastrointestinal bleeding
Hisham Hussan, Nicholas R Crews, Caroline M Geremakis, Soubhi Bahna, Jennifer L LaBundy, Christine Hachem
Hisham Hussan, Section of Intestinal Neoplasia and Hereditary Polyposis (INHP), Department of Gastroenterology, Hepatology and Nutrition, The Ohio State University Medical Center, Columbus, OH 43210, United States
Hisham Hussan, Jennifer L LaBundy, Christine Hachem, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, MO 63110, United States
Nicholas R Crews, School of Medicine, Saint Louis University School of Medicine, Saint Louis, MO 63104, United States
Caroline M Geremakis, Center for Outcomes Research, Saint Louis University, Saint Louis, MO 63103, United States
Soubhi Bahna, Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO 63104, United States
Author contributions: Hussan H conceived and drafted the study, data collection, statistical analysis, wrote and revised the manuscript; Crews NR and Bahna S collected data; Geremakis CM statistically analyzed the data; LaBundy JL and Hachem C drafted study, revised the manuscript.
Correspondence to: Hisham Hussan, MD, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, 3635 Vista Avenue at Grand Blvd, Saint Louis, MO 63110, United States. hhussan@gmail.com
Telephone: +1-314-5778764 Fax: +1-314-5778125
Received: January 15, 2014
Revised: March 5, 2014
Accepted: May 16, 2014
Published online: June 16, 2014
Abstract

AIM: To identify patients’ characteristics associated with double balloon endoscopy (DBE) outcomes in investigation of obscure gastrointestinal bleeding (OGIB).

METHODS: Retrospective study performed at an academic tertiary referral center. Evaluated endpoints were clinical factors associated with no diagnostic yield or non-therapeutic intervention of DBE performed for OGIB evaluation.

RESULTS: We included fifty-five DBE between August 2010 and April 2012. The mean age of the sample was 67 with 32 males (58.2%). Twenty-four DBE had no diagnostic yield and 30 DBE did not require therapy. Non-diagnostic yield was associated with performing two or more DBE studies in one day [odds ratio (OR): 13.72, P = 0.008], absence of blood transfusions within a year of the DBE (OR: 7.16, P = 0.03) and absence of ulcers or arteriovenous malformations (AVMs) on prior esophagogastroduodenoscopy (EGD) or colonoscopy (OR: 19.30, P = 0.033). Non-therapeutic DBE was associated with performing two or more DBE per day (OR: 18.579, P = 0.007), gastrointestinal bleeding episode within a week of the DBE (OR: 11.48, P = 0.003), fewer blood transfusion requirements prior to DBE (OR: 4.55, P = 0.036) and absence of ulcers or AVMs on prior EGD or colonoscopy (OR: 8.47, P = 0.027).

CONCLUSION: Predictors of DBE yield and therapeutic intervention on DBE include blood transfusion requirements, previous endoscopic findings and possibly endoscopist fatigue.

Keywords: Double balloon endoscopy, Enteroscopy, Obscure gastrointestinal bleeding, Small bowel, Anemia, Arteriovenous malformations, Arteriovenous malformations

Core tip: Double balloon endoscopy (DBE) is an excellent tool to visualize the small bowel and provide treatment. However, it may be unable to identify a source for bleeding in 20% to 40% of obscure gastrointestinal bleeding (OGIB) cases. This small retrospective case-control study showed that factors such as fewer blood transfusion requirements, absence of arteriovenous malformations or ulcers on prior endoscopies and possibly endoscopist fatigue may predict a negative diagnostic and therapeutic yield of DBE. This may help manage patients with OGIB and multiple comorbidities and potentially reduce health care costs by classifying patients who are most likely to benefit from this time intensive procedure.