Outcome after enteroscopy for patients with obscure GI bleeding: diagnostic comparison between double-balloon endoscopy and videocapsule endoscopy

Background: Double-balloon endoscopy (DBE) and videocapsule endoscopy (VCE) have been useful in managing obscure GI bleeding (OGIB). Objective: This study compared diagnostic yields of OGIB between DBE and VCE, and evaluated the outcome after DBE. Design: A single-center retrospective study. Setting: A tertiary-referral hospital. Patients: Between June 2003 and February 2007, 162 consecutive patients with OGIB were enrolled and treated. The diagnostic yield between WE and DBE was compared in 74 patients. Main Outcome Measurements: Comparison of diagnostic yields between DBE and VCE, and the prognosis after DBE. Results: Of 162 patients, 95 (59%) were diagnosed with small-bowel diseases. They were treated by medical, enteroscopic, and surgical therapies (n = 35, 30, and 30, respectively). A comparison of the overall diagnostic yield between DBE (64%) and VCE (54%) was not significantly different. The 4 VCE-positive DBE-negative cases were because of inaccessibility of DBE. The 11 VCE-negative DBE-positive cases were because of a failure to detect lesions in the proximal small bowel and the Roux-en-Y loop, and because of diverticula. At a median follow-up of 555 days after DBE, 11 patients with small-bowel diseases developed rebleeding; all were treated by enteroscopic or medical therapies. Vascular diseases, comorbidities, especially portal hypertensive disease and chronic renal failure that required hemodialysis, and sever anemia (Hb <= 7.0 g/dL) were associated with rebleeding. Limitations: A retrospective comparative study, and participation bias. Conclusions: A complementary combination between DBE and VCE was useful for the management of OGIB. In particular, patients with vascular disease, comorbidities, and severe anemia should be intensively treated. (Gastrointest Endosc 2009;69:866-74.)