Push enteroscopy in management of suspected small bowel diseases: Is it still needed

Background and Study Aims: Small intestinal lesions still represent a challenge in diagnosis and treatment. The detection of small bowel lesions has been difficult due to limited visualization of the small bowel by esophagogastroduodenoscopy (EGD) and colonoscopy. In this study, we aimed to assess the efficacy of push enteroscopy (PE) in diagnosis and therapy of small bowel lesions in different indications in a single gastrointestinal (GI) endoscopy center. Patients and Methods : In the period from January 2012 to December 2013, 14 patients presented with different indications referred to the Tanta Endoscopy Center, a division of the internal medicine department and one of the most important centers in Delta Nile in Egypt. Patients were referred due to different indications, and they underwent examination by PE. Results : The overall diagnostic yield for patients with suspected small bowel disease was 57% and for patients with both occult and overt obscure bleeding 63%. Ectopic jejunal varices was the most common diagnosis in patients with GI blood loss. Patients with active overt GI bleeding had a higher diagnostic yield. The procedure was tolerated well, and no complications occurred. Conclusions: Additional endoscopic evaluation of the proximal small bowel by PE should be considered in all patients with nonspecific findings on EGD and colonoscopy especially with occult or overt bleeding, balloon-assisted enteroscopy may be not readily available and capsule endoscopy is expensive.