Clinical impact of double Balloon enteroscopy in obscure bleeding

Obscure bleeding may be presented in 2 two way; occult (no obvious bleeding in stool) and overt (melena or hematochezia). Source of obscure bleeding is small bowel (from second part of duodenum to ileocecal valv) in %3-5 of patients. Recently double balloon enteroscopy (DBE) was developed. Now it is routinely use in clinic practice. This is an important development in endoscopic practice, which enables tissue sampling and interventional therapies. We aimed to evaluate the clinical impact of DBE in obscure bleeding.Seventy-five patients were enrolled to this study. Mean age of patients were 50.8±16.2 years (16-80 years) and 57.3% (n=43) of them were male. Fourty-five patients had obscure bleeding (32% overt; 28% occult) and 30 patients (40%) had iron deficiency anemia. DBE were performed by antegrade in 60 pts (80%), retrograde in 5 pts (6. %7) and antegrade plus retrograde in 10 pts (%13.3). Total enteroscopy rate was 16%. Diagnostic yield of DBE was 75%. This rate is significantly higher in overt bleeding (91.7%, p=0.029). Endoscopic findings were as follows in 56 lesion detected pts: vascular malformation 35.7% (n=20), ulcer 30.4% (n=17), mass 21.4% (n=12), polyp 7.1% (n=4), nodularity %3.6 (n=2), Meckel diverticula 1.8% (n=1). The most common malign lesions were adenocarcinoma (9.3%) and GIST (8%) in all pts. APC were performed in 26.7% (n=20) of pts and polypectomia was performed in 2 pts. Surgical treatment was done in %29.3 of them.As a conclusion, DBE is safe and useful method for diagnosis of obscure bleeding especially overt bleeding. The most important feature is providing therapeutic endoscopy that is the major distinction between the other small bowel imaging methods.