Assessment of multi-modality evaluations of obscure gastrointestinal bleeding

AIM To determine the frequency of bleeding source detection in patients with obscure gastrointestinal bleeding（OGIB） who underwent double balloon enteroscopy（DBE） after pre-procedure imaging [multiphase computed tomography enterography（MPCTE）, video capsule endoscopy（VCE）, or both] and assess the impact of imaging on DBE diagnostic yield.METHODS Retrospective cohort study using a prospectively maintained database of all adult patients presenting with OGIB who underwent DBE from September 1st, 2002 to June 30th, 2013 at a single tertiary center.RESULTS Four hundred and ninety five patients（52% females; median age 68 years） underwent DBE for OGIB. AVCE and/or MPCTE performed within 1 year prior to DBE（in 441 patients） increased the diagnostic yield of DBE（67.1% with preceding imaging vs 59.5% without）. Using DBE as the gold standard, VCE and MPCTE had a diagnostic yield of 72.7% and 32.5% respectively. There were no increased odds of finding a bleeding site at DBE compared to VCE（OR = 1.3, P = 0.150）. There were increased odds of finding a bleeding site at DBE compared to MPCTE（OR = 5.9, P < 0.001）. In inpatients with overt OGIB, diagnostic yield of DBE was not affected by preceding imaging.CONCLUSION DBE is a safe and well-tolerated procedure for the diagnosis and treatment of OGIB, with a diagnostic yield that may be increased after obtaining a preceding VCE or MPCTE. However, inpatients with active ongoing bleeding may benefit from proceeding directly to antegrade DBE.