Yield and therapeutic implications of push enteroscopy

A. Chak, M. Koehler, S. Sundaram, G. Cooper, Marcia Canto, M. V. Sivak

Research output: Contribution to journalArticle

Abstract

Push enteroscopy (PE) is indicated in patients (pts) with suspected small bowel gastrointestinal bleeding or suspected small bowel mucosal disease. AIM: To determine the diagnostic yield of PE; identify clinical predictors which may be associated with PE findings; and measure frequency of management changes made on basis of PE results. METHODS: Endoscopy reports, office charts and hospital charts were retrospectively reviewed for 164 pts 170 men, mean age 61) who had PE performed primarily with Olympus SIF-100 video enteroscope (147 pts) during a period of 2 years. Data extraction from charts included details of comorbid illnesses, nonsteroidal (NSAID) use, social history, previous endoscopies, and radiological tests. RESULTS: All 129 patients being evaluated for gastrointestinal bleeding had prior colonoscopies and upper endoscopies, yield on PE of examining the upper tract (UPR) and the jejunum (JEJ) is given in table below: INDICATIONS Pts UPR JEJ R/O Occult Bleed n=65 18(28%) 27(42%) Overt Bleed n=64 27(42%) 19(30%) Diarrhea n=20 1(5%) 8(40%) RIO Mucosal dz n=15 0(0)% 3(20%) In pts evaluated for bleeding, the most common missed lesions on previous EGO were large hiatal hernias (10 pts), peptic ulcers (10 pts), and AVMs (16 pts). Pts with overt bleeding had a trend towards more missed EGD lesions than pts with occult bleeding (p <0.1). Lesions in upper tract were present in 20138 (52%) pts with overt bleeding using NSAIDs compared to 7/26 (27%) pts not on NSAIDs (p <0.05). Jejunal AVMs were found in 11/32 134%) pts with AVMs on prior EGD or colonoscopy compared to 15/97 (15%) pts with no prior history of AVMs (p <0.001). Management changes, made in 56/129 (43%) pts with bleeding indications, included small bowel resection in 9 (7%) pts and endoscopic therapy in 21 (16%) pts. Management changes were also made in 9/20 (45%) pts with diarrhea. CONCLUSIONS: 1. Push enteroscopy with video enteroscopes has a moderate diagnostic yield in the evaluation of suspected small bowel bleeding and diarrhea leading to changes in management in most of these patients; 2. Large hiatal hernias remain an underrecognized etiology of anemia at EGD; and 3. Repeat EGD should be considered prior to PE in patients with overt bleeding, specially in pts with a history of NSAID use.

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
Volume45
Issue number4
StatePublished - 1997
Externally publishedYes

Fingerprint

Hemorrhage
Therapeutics
Non-Steroidal Anti-Inflammatory Agents
Endoscopy
Diarrhea
Hiatal Hernia
Jejunum
Colonoscopy
Peptic Ulcer
Anemia
History

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Chak, A., Koehler, M., Sundaram, S., Cooper, G., Canto, M., & Sivak, M. V. (1997). Yield and therapeutic implications of push enteroscopy. Gastrointestinal Endoscopy, 45(4).

Yield and therapeutic implications of push enteroscopy. / Chak, A.; Koehler, M.; Sundaram, S.; Cooper, G.; Canto, Marcia; Sivak, M. V.

In: Gastrointestinal Endoscopy, Vol. 45, No. 4, 1997.

Research output: Contribution to journalArticle

Chak, A, Koehler, M, Sundaram, S, Cooper, G, Canto, M & Sivak, MV 1997, 'Yield and therapeutic implications of push enteroscopy', Gastrointestinal Endoscopy, vol. 45, no. 4.
Chak A, Koehler M, Sundaram S, Cooper G, Canto M, Sivak MV. Yield and therapeutic implications of push enteroscopy. Gastrointestinal Endoscopy. 1997;45(4).
Chak, A. ; Koehler, M. ; Sundaram, S. ; Cooper, G. ; Canto, Marcia ; Sivak, M. V. / Yield and therapeutic implications of push enteroscopy. In: Gastrointestinal Endoscopy. 1997 ; Vol. 45, No. 4.
@article{3dadd3cddff247f3bb0efc6eb82c368c,
title = "Yield and therapeutic implications of push enteroscopy",
abstract = "Push enteroscopy (PE) is indicated in patients (pts) with suspected small bowel gastrointestinal bleeding or suspected small bowel mucosal disease. AIM: To determine the diagnostic yield of PE; identify clinical predictors which may be associated with PE findings; and measure frequency of management changes made on basis of PE results. METHODS: Endoscopy reports, office charts and hospital charts were retrospectively reviewed for 164 pts 170 men, mean age 61) who had PE performed primarily with Olympus SIF-100 video enteroscope (147 pts) during a period of 2 years. Data extraction from charts included details of comorbid illnesses, nonsteroidal (NSAID) use, social history, previous endoscopies, and radiological tests. RESULTS: All 129 patients being evaluated for gastrointestinal bleeding had prior colonoscopies and upper endoscopies, yield on PE of examining the upper tract (UPR) and the jejunum (JEJ) is given in table below: INDICATIONS Pts UPR JEJ R/O Occult Bleed n=65 18(28{\%}) 27(42{\%}) Overt Bleed n=64 27(42{\%}) 19(30{\%}) Diarrhea n=20 1(5{\%}) 8(40{\%}) RIO Mucosal dz n=15 0(0){\%} 3(20{\%}) In pts evaluated for bleeding, the most common missed lesions on previous EGO were large hiatal hernias (10 pts), peptic ulcers (10 pts), and AVMs (16 pts). Pts with overt bleeding had a trend towards more missed EGD lesions than pts with occult bleeding (p <0.1). Lesions in upper tract were present in 20138 (52{\%}) pts with overt bleeding using NSAIDs compared to 7/26 (27{\%}) pts not on NSAIDs (p <0.05). Jejunal AVMs were found in 11/32 134{\%}) pts with AVMs on prior EGD or colonoscopy compared to 15/97 (15{\%}) pts with no prior history of AVMs (p <0.001). Management changes, made in 56/129 (43{\%}) pts with bleeding indications, included small bowel resection in 9 (7{\%}) pts and endoscopic therapy in 21 (16{\%}) pts. Management changes were also made in 9/20 (45{\%}) pts with diarrhea. CONCLUSIONS: 1. Push enteroscopy with video enteroscopes has a moderate diagnostic yield in the evaluation of suspected small bowel bleeding and diarrhea leading to changes in management in most of these patients; 2. Large hiatal hernias remain an underrecognized etiology of anemia at EGD; and 3. Repeat EGD should be considered prior to PE in patients with overt bleeding, specially in pts with a history of NSAID use.",
author = "A. Chak and M. Koehler and S. Sundaram and G. Cooper and Marcia Canto and Sivak, {M. V.}",
year = "1997",
language = "English (US)",
volume = "45",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Yield and therapeutic implications of push enteroscopy

AU - Chak, A.

AU - Koehler, M.

AU - Sundaram, S.

AU - Cooper, G.

AU - Canto, Marcia

AU - Sivak, M. V.

PY - 1997

Y1 - 1997

N2 - Push enteroscopy (PE) is indicated in patients (pts) with suspected small bowel gastrointestinal bleeding or suspected small bowel mucosal disease. AIM: To determine the diagnostic yield of PE; identify clinical predictors which may be associated with PE findings; and measure frequency of management changes made on basis of PE results. METHODS: Endoscopy reports, office charts and hospital charts were retrospectively reviewed for 164 pts 170 men, mean age 61) who had PE performed primarily with Olympus SIF-100 video enteroscope (147 pts) during a period of 2 years. Data extraction from charts included details of comorbid illnesses, nonsteroidal (NSAID) use, social history, previous endoscopies, and radiological tests. RESULTS: All 129 patients being evaluated for gastrointestinal bleeding had prior colonoscopies and upper endoscopies, yield on PE of examining the upper tract (UPR) and the jejunum (JEJ) is given in table below: INDICATIONS Pts UPR JEJ R/O Occult Bleed n=65 18(28%) 27(42%) Overt Bleed n=64 27(42%) 19(30%) Diarrhea n=20 1(5%) 8(40%) RIO Mucosal dz n=15 0(0)% 3(20%) In pts evaluated for bleeding, the most common missed lesions on previous EGO were large hiatal hernias (10 pts), peptic ulcers (10 pts), and AVMs (16 pts). Pts with overt bleeding had a trend towards more missed EGD lesions than pts with occult bleeding (p <0.1). Lesions in upper tract were present in 20138 (52%) pts with overt bleeding using NSAIDs compared to 7/26 (27%) pts not on NSAIDs (p <0.05). Jejunal AVMs were found in 11/32 134%) pts with AVMs on prior EGD or colonoscopy compared to 15/97 (15%) pts with no prior history of AVMs (p <0.001). Management changes, made in 56/129 (43%) pts with bleeding indications, included small bowel resection in 9 (7%) pts and endoscopic therapy in 21 (16%) pts. Management changes were also made in 9/20 (45%) pts with diarrhea. CONCLUSIONS: 1. Push enteroscopy with video enteroscopes has a moderate diagnostic yield in the evaluation of suspected small bowel bleeding and diarrhea leading to changes in management in most of these patients; 2. Large hiatal hernias remain an underrecognized etiology of anemia at EGD; and 3. Repeat EGD should be considered prior to PE in patients with overt bleeding, specially in pts with a history of NSAID use.

AB - Push enteroscopy (PE) is indicated in patients (pts) with suspected small bowel gastrointestinal bleeding or suspected small bowel mucosal disease. AIM: To determine the diagnostic yield of PE; identify clinical predictors which may be associated with PE findings; and measure frequency of management changes made on basis of PE results. METHODS: Endoscopy reports, office charts and hospital charts were retrospectively reviewed for 164 pts 170 men, mean age 61) who had PE performed primarily with Olympus SIF-100 video enteroscope (147 pts) during a period of 2 years. Data extraction from charts included details of comorbid illnesses, nonsteroidal (NSAID) use, social history, previous endoscopies, and radiological tests. RESULTS: All 129 patients being evaluated for gastrointestinal bleeding had prior colonoscopies and upper endoscopies, yield on PE of examining the upper tract (UPR) and the jejunum (JEJ) is given in table below: INDICATIONS Pts UPR JEJ R/O Occult Bleed n=65 18(28%) 27(42%) Overt Bleed n=64 27(42%) 19(30%) Diarrhea n=20 1(5%) 8(40%) RIO Mucosal dz n=15 0(0)% 3(20%) In pts evaluated for bleeding, the most common missed lesions on previous EGO were large hiatal hernias (10 pts), peptic ulcers (10 pts), and AVMs (16 pts). Pts with overt bleeding had a trend towards more missed EGD lesions than pts with occult bleeding (p <0.1). Lesions in upper tract were present in 20138 (52%) pts with overt bleeding using NSAIDs compared to 7/26 (27%) pts not on NSAIDs (p <0.05). Jejunal AVMs were found in 11/32 134%) pts with AVMs on prior EGD or colonoscopy compared to 15/97 (15%) pts with no prior history of AVMs (p <0.001). Management changes, made in 56/129 (43%) pts with bleeding indications, included small bowel resection in 9 (7%) pts and endoscopic therapy in 21 (16%) pts. Management changes were also made in 9/20 (45%) pts with diarrhea. CONCLUSIONS: 1. Push enteroscopy with video enteroscopes has a moderate diagnostic yield in the evaluation of suspected small bowel bleeding and diarrhea leading to changes in management in most of these patients; 2. Large hiatal hernias remain an underrecognized etiology of anemia at EGD; and 3. Repeat EGD should be considered prior to PE in patients with overt bleeding, specially in pts with a history of NSAID use.

UR - http://www.scopus.com/inward/record.url?scp=7344225282&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=7344225282&partnerID=8YFLogxK

M3 - Article

AN - SCOPUS:7344225282

VL - 45

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 4

ER -