Double balloon enteroscopy detects small bowel mass lesions missed by capsule endoscopy

Andrew Ross, Shahab Mehdizadeh, Jeffrey Tokar, Jonathan A Leighton, Ahmad Kamal, Ann Chen, Drew Schembre, Gary Chen, Kenneth Binmoeller, Richard Kozarek, Irving Waxman, Charles Dye, Lauren Gerson, M. Edwyn Harrison, Oleh Haluszka, Simon Lo, Carol Semrad

Research output: Contribution to journalArticle

157 Citations (Scopus)

Abstract

Background: Small bowel mass lesions (SBML) are a relatively common cause of obscure gastrointestinal bleeding (OGIB). Their detection has been limited by the inability to endoscopically examine the entire small intestine. This has changed with the introduction of capsule endoscopy (CE) and double balloon enteroscopy (DBE) into clinical practice. Study Aim: To evaluate the detection of SBML by DBE and CE in patients with OGIB who were found to have SBML by DBE and underwent both procedures. Methods: A retrospective review of a prospectively collected database of all patients undergoing DBE for OGIB at seven North American tertiary centers was performed. Those patients who were found to have SBML as a cause of their OGIB were further analyzed. Results: During an 18 month period, 183 patients underwent DBE for OGIB. A small bowel mass lesion was identified in 18 patients. Of these, 15 patients had prior CE. Capsule endoscopy identified the mass lesion in five patients; fresh luminal blood with no underlying lesion in seven patients, and non-specific erythema in three patients. Capsule endoscopy failed to identify all four cases of primary small bowel adenocarcinoma. Conclusions: Double balloon enteroscopy detects small bowel mass lesions responsible for OGIB that are missed by CE. Additional endoscopic evaluation of the small bowel by DBE or intraoperative enteroscopy should be performed in patients with ongoing OGIB and negative or non-specific findings on CE.

Original languageEnglish (US)
Pages (from-to)2140-2143
Number of pages4
JournalDigestive Diseases and Sciences
Volume53
Issue number8
DOIs
StatePublished - Aug 2008

Fingerprint

Double-Balloon Enteroscopy
Capsule Endoscopy
Hemorrhage
Erythema
Small Intestine
Adenocarcinoma

Keywords

  • Enteroscopy
  • Neoplasm
  • Obscure gastrointestinal bleeding
  • Small bowel

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Double balloon enteroscopy detects small bowel mass lesions missed by capsule endoscopy. / Ross, Andrew; Mehdizadeh, Shahab; Tokar, Jeffrey; Leighton, Jonathan A; Kamal, Ahmad; Chen, Ann; Schembre, Drew; Chen, Gary; Binmoeller, Kenneth; Kozarek, Richard; Waxman, Irving; Dye, Charles; Gerson, Lauren; Harrison, M. Edwyn; Haluszka, Oleh; Lo, Simon; Semrad, Carol.

In: Digestive Diseases and Sciences, Vol. 53, No. 8, 08.2008, p. 2140-2143.

Research output: Contribution to journalArticle

Ross, A, Mehdizadeh, S, Tokar, J, Leighton, JA, Kamal, A, Chen, A, Schembre, D, Chen, G, Binmoeller, K, Kozarek, R, Waxman, I, Dye, C, Gerson, L, Harrison, ME, Haluszka, O, Lo, S & Semrad, C 2008, 'Double balloon enteroscopy detects small bowel mass lesions missed by capsule endoscopy', Digestive Diseases and Sciences, vol. 53, no. 8, pp. 2140-2143. https://doi.org/10.1007/s10620-007-0110-0
Ross, Andrew ; Mehdizadeh, Shahab ; Tokar, Jeffrey ; Leighton, Jonathan A ; Kamal, Ahmad ; Chen, Ann ; Schembre, Drew ; Chen, Gary ; Binmoeller, Kenneth ; Kozarek, Richard ; Waxman, Irving ; Dye, Charles ; Gerson, Lauren ; Harrison, M. Edwyn ; Haluszka, Oleh ; Lo, Simon ; Semrad, Carol. / Double balloon enteroscopy detects small bowel mass lesions missed by capsule endoscopy. In: Digestive Diseases and Sciences. 2008 ; Vol. 53, No. 8. pp. 2140-2143.
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AU - Ross, Andrew

AU - Mehdizadeh, Shahab

AU - Tokar, Jeffrey

AU - Leighton, Jonathan A

AU - Kamal, Ahmad

AU - Chen, Ann

AU - Schembre, Drew

AU - Chen, Gary

AU - Binmoeller, Kenneth

AU - Kozarek, Richard

AU - Waxman, Irving

AU - Dye, Charles

AU - Gerson, Lauren

AU - Harrison, M. Edwyn

AU - Haluszka, Oleh

AU - Lo, Simon

AU - Semrad, Carol

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N2 - Background: Small bowel mass lesions (SBML) are a relatively common cause of obscure gastrointestinal bleeding (OGIB). Their detection has been limited by the inability to endoscopically examine the entire small intestine. This has changed with the introduction of capsule endoscopy (CE) and double balloon enteroscopy (DBE) into clinical practice. Study Aim: To evaluate the detection of SBML by DBE and CE in patients with OGIB who were found to have SBML by DBE and underwent both procedures. Methods: A retrospective review of a prospectively collected database of all patients undergoing DBE for OGIB at seven North American tertiary centers was performed. Those patients who were found to have SBML as a cause of their OGIB were further analyzed. Results: During an 18 month period, 183 patients underwent DBE for OGIB. A small bowel mass lesion was identified in 18 patients. Of these, 15 patients had prior CE. Capsule endoscopy identified the mass lesion in five patients; fresh luminal blood with no underlying lesion in seven patients, and non-specific erythema in three patients. Capsule endoscopy failed to identify all four cases of primary small bowel adenocarcinoma. Conclusions: Double balloon enteroscopy detects small bowel mass lesions responsible for OGIB that are missed by CE. Additional endoscopic evaluation of the small bowel by DBE or intraoperative enteroscopy should be performed in patients with ongoing OGIB and negative or non-specific findings on CE.

AB - Background: Small bowel mass lesions (SBML) are a relatively common cause of obscure gastrointestinal bleeding (OGIB). Their detection has been limited by the inability to endoscopically examine the entire small intestine. This has changed with the introduction of capsule endoscopy (CE) and double balloon enteroscopy (DBE) into clinical practice. Study Aim: To evaluate the detection of SBML by DBE and CE in patients with OGIB who were found to have SBML by DBE and underwent both procedures. Methods: A retrospective review of a prospectively collected database of all patients undergoing DBE for OGIB at seven North American tertiary centers was performed. Those patients who were found to have SBML as a cause of their OGIB were further analyzed. Results: During an 18 month period, 183 patients underwent DBE for OGIB. A small bowel mass lesion was identified in 18 patients. Of these, 15 patients had prior CE. Capsule endoscopy identified the mass lesion in five patients; fresh luminal blood with no underlying lesion in seven patients, and non-specific erythema in three patients. Capsule endoscopy failed to identify all four cases of primary small bowel adenocarcinoma. Conclusions: Double balloon enteroscopy detects small bowel mass lesions responsible for OGIB that are missed by CE. Additional endoscopic evaluation of the small bowel by DBE or intraoperative enteroscopy should be performed in patients with ongoing OGIB and negative or non-specific findings on CE.

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