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 im...

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Veröffentlicht in:World journal of gastroenterology : WJG 2017-01, Vol.23 (4), p.614-621
Hauptverfasser: Law, Ryan, Varayil, Jithinraj E, WongKeeSong, Louis M, Fidler, Jeff, Fletcher, Joel G, Barlow, John, Alexander, Jeffrey, Rajan, Elizabeth, Hansel, Stephanie, Becker, Brenda, Larson, Joseph J, Enders, Felicity T, Bruining, David H, Coelho-Prabhu, Nayantara
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container_end_page 621
container_issue 4
container_start_page 614
container_title World journal of gastroenterology : WJG
container_volume 23
creator Law, Ryan
Varayil, Jithinraj E
WongKeeSong, Louis M
Fidler, Jeff
Fletcher, Joel G
Barlow, John
Alexander, Jeffrey
Rajan, Elizabeth
Hansel, Stephanie
Becker, Brenda
Larson, Joseph J
Enders, Felicity T
Bruining, David H
Coelho-Prabhu, Nayantara
description 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.
doi_str_mv 10.3748/wjg.v23.i4.614
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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 &amp;lt; 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.</description><identifier>ISSN: 1007-9327</identifier><identifier>EISSN: 2219-2840</identifier><identifier>DOI: 10.3748/wjg.v23.i4.614</identifier><identifier>PMID: 28216967</identifier><language>eng</language><publisher>United States: Baishideng Publishing Group Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Capsule Endoscopy ; Double-Balloon Enteroscopy ; Endoscopes, Gastrointestinal ; Female ; Gastrointestinal Hemorrhage - diagnostic imaging ; Gastrointestinal Hemorrhage - etiology ; Humans ; Male ; Middle Aged ; Multimodal Imaging ; Reproducibility of Results ; Retrospective Cohort Study ; Retrospective Studies ; Tertiary Care Centers ; Tomography, X-Ray Computed ; Young Adult</subject><ispartof>World journal of gastroenterology : WJG, 2017-01, Vol.23 (4), p.614-621</ispartof><rights>The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved. 2017</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c434t-8ff2ecc99496b1711ba7e7cc90fe6f4c79e3e1e893640806cfce87043eaf066c3</citedby><cites>FETCH-LOGICAL-c434t-8ff2ecc99496b1711ba7e7cc90fe6f4c79e3e1e893640806cfce87043eaf066c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Uhttp://image.cqvip.com/vip1000/qk/84123X/84123X.jpg</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292334/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292334/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28216967$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Law, Ryan</creatorcontrib><creatorcontrib>Varayil, Jithinraj E</creatorcontrib><creatorcontrib>WongKeeSong, Louis M</creatorcontrib><creatorcontrib>Fidler, Jeff</creatorcontrib><creatorcontrib>Fletcher, Joel G</creatorcontrib><creatorcontrib>Barlow, John</creatorcontrib><creatorcontrib>Alexander, Jeffrey</creatorcontrib><creatorcontrib>Rajan, Elizabeth</creatorcontrib><creatorcontrib>Hansel, Stephanie</creatorcontrib><creatorcontrib>Becker, Brenda</creatorcontrib><creatorcontrib>Larson, Joseph J</creatorcontrib><creatorcontrib>Enders, Felicity T</creatorcontrib><creatorcontrib>Bruining, David H</creatorcontrib><creatorcontrib>Coelho-Prabhu, Nayantara</creatorcontrib><title>Assessment of multi-modality evaluations of obscure gastrointestinal bleeding</title><title>World journal of gastroenterology : WJG</title><addtitle>World Journal of Gastroenterology</addtitle><description>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 &amp;lt; 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. 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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 &amp;lt; 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.</abstract><cop>United States</cop><pub>Baishideng Publishing Group Inc</pub><pmid>28216967</pmid><doi>10.3748/wjg.v23.i4.614</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record>
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subjects Adolescent
Adult
Aged
Aged, 80 and over
Capsule Endoscopy
Double-Balloon Enteroscopy
Endoscopes, Gastrointestinal
Female
Gastrointestinal Hemorrhage - diagnostic imaging
Gastrointestinal Hemorrhage - etiology
Humans
Male
Middle Aged
Multimodal Imaging
Reproducibility of Results
Retrospective Cohort Study
Retrospective Studies
Tertiary Care Centers
Tomography, X-Ray Computed
Young Adult
title Assessment of multi-modality evaluations of obscure gastrointestinal bleeding
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