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.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging