Sa1642 Effectiveness of Double Balloon Enteroscopy for Obscure Gastrointestinal Bleeding : a Multicenter Retrospective Cohort Study by Osaka Gut Forum

Effectiveness of Double Balloon Enteroscopy for Obscure Gastrointestinal Bleeding : a Multicenter Retrospective Cohort Study by Osaka Gut Forum Akira Maekawa*, Masato Komori, Satoshi Egawa, Shinjirou Yamaguchi, Kunio Suzuki, Sachiko Nakajima, Hiroyuki Ogawa, Takashi Ueda, Satoshi Hiyama, Takahiro Inoue, Takuya Yamada, Shinichiro Shinzaki, Tsutomu Nishida, Hideki Iijima, Masahiko Tsujii, Tetsuo Takehara Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan; Department of Gastroenterology, Osaka Rousai Hospital, Sakai, Japan; Department of Gastroenterology, Kansai Rousai Hospital, Amagasaki, Japan; Department of Gastroenterology, Osaka Police Hospital, Osaka, Japan; Department of Internal Medicine, Saiseikai Senri Hospital, Suita, Japan; Department of Gastroenterology, NTT-West Osaka Hospital, Osaka, Japan; Department of Gastroenterology, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan; Department of Gastroenterology, Yao Municipal Hospital, Yao, Japan Background and Aim: Double-balloon enteroscopy (DBE) enabled endoscopic approaches to the small intestine and is useful to make accurate diagnosis of the responsible lesions of bleeding in patients with obscure gastrointestinal bleeding (OGIB). It is unknown, however, about the efficacy of DBE in association with bleeding condition. We aimed to investigate the efficacy of DBE for the diagnosis of occult and overt OGIB in a multi-center cohort. Methods: We analyzed 323 patients who underwent DBE due to OGIB between June 2004 and September 2012 in tertiary-care hospitals of Osaka Gut Forum. Overt OGIB was defined as with visible GI bleeding, while occult OGIB was with anemia or with a positive fecal occult blood test. Overt OGIB was further differentiated in terms of DBE findings in active overt (i.e., existence of endoscopic ongoing bleeding or bloody residue) and inactive overt bleeding. Results: We performed 430 DBE in 277 patients with overt OGIB (162 male, 115 female; mean age, 67 years; range, 15-91 years) and 46 DBE in 82 patients with occult OGIB (29 male, 17 female; mean age, 66 years; range, 17-84 years). Detection rate of the bleeding lesion was 55% (152/277) in patients with overt OGIB, including ulceration in 53 patients (35%), vascular lesions in 35 patients (23%), and neoplastic lesions in 18 patients (18%). Seventy lesions were diagnosed in oral DBE, while 82 were diagnosed in anal DBE. Detection rate of bleeding lesion was 49% (21/46) in patients with occult OGIB and was similar to that of overt OGIB. These lesions included ulceration in 8 patients (38%), vascular lesions in 4 patients (19%), and neoplastic lesions in 4 patients (19%). Nine lesions were diagnosed in oral DBE, while 12 were diagnosed in anal DBE. In 277 patients with overt OGIB, 49 patients showed endoscopically active bleeding by DBE and 228 did not. The shorter time from bleeding symptom till DBE, the more active bleeding was detected. The proportion of ulcer lesions was lower in active bleeding patients (26%) than in inactive patients (38%). In contrast, vascular lesions were significantly higher in patients with active bleeding (33%) than that of patients with inactive bleeding (19%). Conclusions: The detection rate of the bleeding lesions using DBE was similar between overt and occult OGIB and ulceration is most commonly observed in both overt and occult OGIB. Endoscopists should bear in mind that the types of lesions responsible for bleeding are different in terms of bleeding conditions.