Double Balloon Enteroscopy Detects Small Bowel Mass Lesions Missed by Capsule Endoscopy

• Published in: Digestive diseases and sciences Vol. 53; no. 8; pp. 2140 - 2143
• Main Authors: Ross, Andrew, Mehdizadeh, Shahab, Tokar, Jeffrey, Leighton, Jonathan A., Kamal, Ahmad, Chen, Ann, Schembre, Drew, Chen, Gary, Binmoeller, Kenneth, Kozarek, Richard, Waxman, Irving, Dye, Charles, Gerson, Lauren, Harrison, M. Edwyn, Haluszka, Oleh, Lo, Simon, Semrad, Carol
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.08.2008; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Biochemistry; Biological and medical sciences; Capsule Endoscopy; Diagnostic Errors - prevention & control; Digestive system. Abdomen; Endoscopy; Endoscopy, Gastrointestinal - methods; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - pathology; Hepatology; Humans; Intestinal Neoplasms - complications; Intestinal Neoplasms - pathology; Intestine, Small - pathology; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Oncology; Original Paper; Other diseases. Semiology; Predictive Value of Tests; Registries; Retrospective Studies; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Transplant Surgery; United States; Vertebrates: anatomy and physiology, studies on body, several organs or systems; United States; Neoplasm; Small bowel; Obscure gastrointestinal bleeding; Enteroscopy; Gastrointestinal bleeding; Capsule endoscopy; Double balloon enteroscopy; Gastroenterology; Digestive diseases; Intestinal disease; Metabolic diseases; Enteroscopy .Small bowel .Neoplasm; Lesion; Small intestine
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-007-0110-0

Background Small bowel mass lesions (SBML) are a relatively common cause of obscure gastrointestinal bleeding (OGIB). Their detection has been limited by the inability to endoscopically examine the entire small intestine. This has changed with the introduction of capsule endoscopy (CE) and double balloon enteroscopy (DBE) into clinical practice. Study Aim To evaluate the detection of SBML by DBE and CE in patients with OGIB who were found to have SBML by DBE and underwent both procedures. Methods A retrospective review of a prospectively collected database of all patients undergoing DBE for OGIB at seven North American tertiary centers was performed. Those patients who were found to have SBML as a cause of their OGIB were further analyzed. Results During an 18 month period, 183 patients underwent DBE for OGIB. A small bowel mass lesion was identified in 18 patients. Of these, 15 patients had prior CE. Capsule endoscopy identified the mass lesion in five patients; fresh luminal blood with no underlying lesion in seven patients, and non-specific erythema in three patients. Capsule endoscopy failed to identify all four cases of primary small bowel adenocarcinoma. Conclusions Double balloon enteroscopy detects small bowel mass lesions responsible for OGIB that are missed by CE. Additional endoscopic evaluation of the small bowel by DBE or intraoperative enteroscopy should be performed in patients with ongoing OGIB and negative or non-specific findings on CE.