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Sa1639 Is It Worth Pursuing Double Balloon Enteroscopy After Capsule Endoscopy in the Elderly? Findings From a Single Center Experience
Abstracts
Sa1637 Characteristics of the Small Bowel Lesions Detected by Capsule Endoscopy in Patients With Chronic Kidney Disease Harunobu Kawamura*, Eiji Sakai, Hiroki Endo, Eiji Yamada, Takuma Higurashi, Hidenori Ohkubo, Hirokazu Takahashi, Atsushi Nakajima Gastroenterology, Yokohama Coty University School of Medicine, Yokohama, Japan Background and Aims: Obscure gastrointestinal bleeding (OGIB) is one of the common complications in patients with chronic kidney disease (CKD), especially those who are on maintenance hemodialysis (HD). However, little is known about the characteristics of the small bowel lesions detectable by capsule endoscopy (CE) in these patients, or of the factors that could predict the presence of such lesions. Therefore we conducted a present study which investigating characteristics of the small bowel lesions detected by CE in CKD patients. Methods: A total of 42 CKD patients (including 19 patients on maintenance HD (HD patients) and 23 patients not on (non-HD patients)) and 132 age- and- sex adjusted non-CKD patients were the subjects of this study. The incidences of the small bowel vascular lesions and erosive/ulcerated lesions were compared among the groups. Furthermore, univariate and multivariate logistic-regression analyses were performed to identify predictive factors for the presence of small bowel lesions in the CKD patients. Results: The total diagnostic yield of CE was significantly higher in the CKD patients as compared to the nonCKD patients (64.2% and 44.7%, respectively, P ⫽ 0.04). The incidence of vascular lesions was also significantly higher in the CKD patients compared to the non-CKD patients (47.6% and 20.5%, respectively, P ⬍ 0.001), while the incidence of erosive/ulcerated lesions was not significantly different between the two patient groups (33.3% and 27.3%, respectively, P ⫽ 0.45). On the other hand, there were no significant differences in the incidences of small bowel lesions between the HD patients and non-HD patients. In the CKD patients, past history of blood transfusion (OR 5.66; 95% CI 1.10 - 29.1, P ⫽ 0.04) was identified as an independent predictor of the presence of vascular lesions, and history of low-dose aspirin use (OR 6.00; 95% CI 1.13 - 31.9, P ⫽ 0.04) was identified as a predictor of the presence of erosive/ulcerated lesions. Conclusions: CE examination would be clinically meaningful for identifying the source of OGIB in CKD patients, especially patients with a history of recent blood transfusion and/or LDA use.
Forrest plots comparing complete enteroscopy rate and diagnostic yield between SBE and DBE.
Sa1638 A Meta-Analysis on Efficacy and Safety: Single-Balloon vs. Double-Balloon Enteroscopy Saurabh Sethi*, Douglas K. Pleskow, RAM Chuttani, Tyler M. Berzin, Mandeep Sawhney Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA Background: Double-balloon enteroscopy (DBE) and Single-balloon enteroscopy (SBE) are new techniques capable of deep enteroscopy. Results of individual studies comparing these two techniques have failed to identify a dominant strategy. Objectives: To systematically pool all available studies to compare the efficacy and safety of DBE with SBE for evaluation of the small bowel. Methods: Databases including PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched. Main outcome measures were complete smallbowel visualization, diagnostic yield, therapeutic yield, and complication rate. Statistical analysis was performed using Review Manager (RevMan version 5.0). Meta-analysis was performed using fixed effect or random-effect methods, depending on the absence or presence of significant heterogeneity. We used the 2 test to assess heterogeneity between trials and the I2 statistic to assess the extent of inconsistency. P ⬍ 0.05 was defined as significant heterogeneity. Results were expressed as OR or mean difference with 95% CI. P ⬍ 0.05 was considered statistically significant. Potential publication bias was examined by funnel plot. Results: Three prospective randomized controlled trials with a total of 268 patients were identified. DBE was superior to SBE for ability to visualize the entire small bowel (pooled OR⫽ 0.53 [95% CI: 0.28 to 0.98, p ⫽0.04). DBE was superior to SBE for ability to provide endoscopic therapy (pooled OR ⫽ 0.81 [95 % CI: 0.50 to 1.32, p⫽0.4). DBE and SBE were similar with regard to ability to provide diagnosis (pooled OR⫽ 0.44 [95 % CI: 0.23 to 0.83, p⫽ 0.01). There was no significant difference between DBE and SBE, with regard to complication rate (pooled OR 1.12 [95 % CI: 0.06 to 19.28, p⫽0.94). Conclusions: DBE was superior to SBE with regard to complete small bowel visualization and ability to provide treatment. DBE was similar to SBE with regard to diagnostic yield and complication rate.
Forrest plots comparing therapeutic yield and complication rate between SBE and DBE.
Sa1639 Is It Worth Pursuing Double Balloon Enteroscopy After Capsule Endoscopy in the Elderly? Findings From a Single Center Experience Victoria Gomez*, Michael J. Bartel, Mark E. Stark, Frank Lukens Gastroenterology, Mayo Clinic, Jacksonville, FL Introduction: The evaluation of obscure gastrointestinal bleeding and other suspected occult diseases of the small intestine involves use of capsule endoscopy (CE) and often times followed by double balloon enteroscopy (DBE). These two modalities are complimentary to each other with satisfactory diagnostic yield. However, DBE has procedureal related risks, and particularly in the very elderly patient population with naturally more co morbidities, has a presumed higher risk of adverse events. However, correlations between CE and DBE findings and overall outcomes of DBE are not well established in this older patient population. Aims: Primary aim was to determine the correlation between CE and DBE findings, followed by secondary aims of indications, findings and outcomes on DBE in the very elderly patient population defined by age ⬎⫽ 80 years. Methods: Review of a large prospectively collected DBE database from 2006 through November 2012. Patients’ demographics along with procedure indication, findings, and complications were recorded. The safety and diagnostic yield of DBE was calculated by frequency statistics. Correlation between findings on capsule endoscopy and DBE was analyzed. Results: During this study period, a total of 3100 DBE procedures were performed, for which 137 patients ⬎⫽ 80
AB276 GASTROINTESTINAL ENDOSCOPY Volume 77, No. 5S : 2013
www.giejournal.org
Abstracts
years of age (55.5% male) underwent a total of 223 DBE procedures (123 antegrade approach). The average age of these patients was 83.5 years (Range 80-94 years). Indications and findings are described in the Table. The most common DBE indication was occult gastrointestinal bleeding (66%). The most common finding was non-bleeding mucosal vascular ectasias (42.6%). A therapeutic intervention (other than diagnostic biopsies) was performed in 134 (60%) procedures. Of the 137 patient’s a total of 114 (83.2%) of these had a capsule endoscopy prior to DBE. Correlation between findings of capsule endoscopy and DBE occurred in 78.9% (see Table). The overall diagnostic (pertinent positive findings) yield of DBE was 89.2%. The diagnostic yield of DBE for gastrointestinal bleeding (occult and overt) was 90.2%. There were no immediate (less than 48 hours) post-procedural complications. Conclusion: Capsule endoscopy has a very high correlation with DBE, and furthermore, DBE can be performed safely in the octogenarian patient population. Given these findings, in an elderly patient with positive findings on CE, DBE should be considered as the next appropriate diagnostic and therapeutic test. Results of double balloon enteroscopy and correlation with capsule endoscopy Variable Indication Occult gastrointestinal bleeding Overt gastrointestinal bleeding Other Findings Nonbleeding vascular ectasia Normal Bleeding vascular ectasia Other Correlation between CE and DBE findings No correlation between CE and DBE findings False positive findings on CE False negative findings on CE
N encounters (%) 147 (66) 58 (26) 18 (8) 95 (42.6) 55 (24.7) 37 (16.6) 36 (16.1) 90/114 (78.9) 24/114 (21.1) 18 (75) 6 (25)
DBE⫽ double balloon enteroscopy. CE⫽ capsule endoscopy
Sa1640 Video Capsule Endoscopy and Double Balloon Enteroscopy in the Evaluation of Obscure Gastrointestinal Bleeding Bryan L. Balmadrid*1, Gulseren Seven1, Richard a. Kozarek1, Andrew S. Ross1, Shayan Irani1, Michael Gluck1, Drew B. Schembre2, Johannes Koch1, S. Ian Gan1 1 Gastroenterology, Virginia Mason Digestive Disease Institute, Seattle, WA; 2Gastroenterology, Swedish Medical Center, Seattle, WA Background: Double balloon enteroscopy (DBE) and video capsule endoscopies (VCE) have both been used in recent years in the evaluation of obscure GI bleed (OGIB). The studies are often complementary and most often performed sequentially, with VCE being performed first and DBE being performed thereafter. Objective: To determine if findings on VCE are predictive of findings at time of DBE and to determine the yield of DBE in VCE-negative patients. Secondary goal was to determine characteristics predictive of positive DBE. Methods: A single tertiary center retrospective database of all patients undergoing DBE between January 2006 and December 2012 was performed. Patients with a history of OGIB who had undergone VCE prior to DBE were identified and findings were compared. We evaluated the yield of DBE in comparison to VCE findings, and to identify patient characteristics that were associated with and increased likelihood of a positive DBE. Results: 177 patients with OGIB were identified. Of these, 148 underwent both VCE and DBE. The mean age was 65.2 years (range 15-94 y) and 55.4% were male. Overall, DBE found potential causes for OGIB in 51.4% compared to 61.1% for VCE. Most commonly identified sources of OGIB on either VCE or DBE were: blood (34.4%), arteriovenous malformations (AVM) (31.1%), ulcer or erosion (21.1%).58 patients had a normal VCE. In these patients, 29.3% (17) had an abnormal DBE with three most common small bowel (SB) findings being AVM (5), ulcer (4), submucosal lesion/polyp/tumor (4), and 2 findings outside of the SB (Cameron’s erosions, oozing left colon polyp). There were 124 abnormal VCE findings with 90 thought to be a potential cause of OGIB. Correlation with the DBE results was found in 41.5% (51). In 52% (64) there was no correlation and in 6.5% of patients (8) correlation was indeterminate. Positive VCE findings and negative VCE findings were associated with an OR of 3.79 (95% CI, 1.87 - 7.68) and OR of 0.26 (95% CI, 0.13 - 0.53), respectively, for positive DBE findings. Other characteristics that predicted positive DBE include: cardiovascular disease (OR 3.33 [95% CI, 1.79 - 6.20]), transfusion history (OR 1.95 [95% CI, 1.03 - 3.69]).DBE therapy was performed in 23.7%. ADBE was performed first in 74.0% compared to 26.0% for RDBE. ADBE was positive in 54.7% compared to 37.1% for RDBE. If a second DBE was performed after the first DBE, the yield was 55.6%. Conclusion: In patients with OGIB, findings on VCE are predictive of findings at DBE but correlation is lower than expected. Negative VCE does not preclude
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positive and treatable findings at DBE. Other characteristics associated with higher DBE yield include history of cardiovascular disease or transfusions. Repeat or reverse directional DBE performed after an initially negative DBE have relatively high yield rates.
Sa1641 Factors Associated With Negative Findings or No Therapy on Double Balloon Endoscopy in the Evaluation of Gastrointestinal Bleeding Hisham Hussan*1, Nicholas R. Crews4, Caroline M. Geremakis3, Soubhi Bahna2, Jennifer L. Labundy1, Christine Hachem1 1 Gastroenterology and Hepatology, Saint Louis University, Saint Louis, MO; 2Internal Medicine, Saint Louis University, Saint Louis, MO; 3 Center for Outcomes Research, Saint Louis University, Saint Louis, MO; 4School of Medicine, Saint Louis University, Saint Louis, MO Background: Obscure GI bleeding (OGIB) is a challenging diagnostic problem for gastroenterologists. Double balloon endoscopy (DBE) offers both diagnostic and therapeutic value in this setting. However, it is invasive, complex, and time-consuming. Aim: We conducted a retrospective study to identify variables associated with negative findings or non-therapeutic DBE performed for evaluating OGIB. Methods: Data were collected from patients who underwent DBE for evaluation of obscure gastrointestinal bleeding at Saint Louis University Hospital between August 1, 2010 and April 6, 2012. We classified DBE’s based on diagnostic findings and therapeutic outcomes. DBE’s were classified as “positive diagnostic” when potential bleeding sources (ulcers, polyps, masses, actively bleeding lesions) were found and correlated with video capsule endoscopy (VCE) findings. Positive therapeutic DBE’s were defined by performance of therapy during DBE to treat a bleeding source. Descriptive statistics, chi square, and logistic regression were conducted to identify demographic and clinical predictors of non-therapeutic or non-diagnostic DBE. Results: A total of 55 DBE were reviewed. Of those, 24 DBE had negative diagnostic findings and 30 DBE did not require therapy. The mean age of the sample was 67 with 32 males (58.2%).Univariate analyses are shown in the table below. In multivariate regression analysis a negative diagnostic DBE was associated with two or more DBE studies per day (OR: 13.72, p ⫽ 0.008) and no blood transfusions in the year prior to DBE (OR: 7.16, p ⫽ 0.03). Nontherapeutic DBE was associated with two or more DBE per day (OR: 18.579, p⫽0.007), a GI bleeding episode within the week prior to DBE (OR: 11.48, p⫽0.003) and blood transfusion requirements of less than or equal to 4 in the past 10 years prior to DBE (OR:4.55, p⫽0.036). Conclusion: Predictors of DBE findings and therapeutic intervention on DBE include ASA score, blood transfusion requirements, and previous findings on upper and lower endoscopy. Also, endoscopist fatigue may play a role in diagnostic and therapeutic yield of DBE in OGIB. More research is needed to optimize diagnostic and therapeutic outcomes in patients with OGIB. Univariate analysis of factors associated with negative diagnostic DBE and negative therapeutic DBE
Variables Pre-DBE ASA score ⱕ 2 Greater than one DBE in one day by single endoscopist GI bleed within 1 week prior to DBE Hgb of ⬎ 9 mg/dl prior to DBE Blood transfusions of less than 4 units in the 10 years prior to DBE No blood transfusions requirement in the year prior to DBE Prior EGD with no ulcers or AVMs Prior EGD and Colonoscopy with no ulcers or AVMs Prior enteroscopy with no AVMs
Negative diagnostic DBE p-value
No therapeutic intervention during DBE p-value
0.611 0.016
.044 0.024
0.179 0.010 0.149
0.010 0.035 0.027
0.019
0.044
0.031 ** 0.001 **
0.004 0.001
0.013
0.009
Fisher exact test **
Volume 77, No. 5S : 2013
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AB277
Sa1637 Characteristics of the Small Bowel Lesions Detected by Capsule Endoscopy in Patients With Chronic Kidney Disease Harunobu Kawamura*, Eiji Sakai, Hiroki Endo, Eiji Yamada, Takuma Higurashi, Hidenori Ohkubo, Hirokazu Takahashi, Atsushi Nakajima Gastroenterology, Yokohama Coty University School of Medicine, Yokohama, Japan Background and Aims: Obscure gastrointestinal bleeding (OGIB) is one of the common complications in patients with chronic kidney disease (CKD), especially those who are on maintenance hemodialysis (HD). However, little is known about the characteristics of the small bowel lesions detectable by capsule endoscopy (CE) in these patients, or of the factors that could predict the presence of such lesions. Therefore we conducted a present study which investigating characteristics of the small bowel lesions detected by CE in CKD patients. Methods: A total of 42 CKD patients (including 19 patients on maintenance HD (HD patients) and 23 patients not on (non-HD patients)) and 132 age- and- sex adjusted non-CKD patients were the subjects of this study. The incidences of the small bowel vascular lesions and erosive/ulcerated lesions were compared among the groups. Furthermore, univariate and multivariate logistic-regression analyses were performed to identify predictive factors for the presence of small bowel lesions in the CKD patients. Results: The total diagnostic yield of CE was significantly higher in the CKD patients as compared to the nonCKD patients (64.2% and 44.7%, respectively, P ⫽ 0.04). The incidence of vascular lesions was also significantly higher in the CKD patients compared to the non-CKD patients (47.6% and 20.5%, respectively, P ⬍ 0.001), while the incidence of erosive/ulcerated lesions was not significantly different between the two patient groups (33.3% and 27.3%, respectively, P ⫽ 0.45). On the other hand, there were no significant differences in the incidences of small bowel lesions between the HD patients and non-HD patients. In the CKD patients, past history of blood transfusion (OR 5.66; 95% CI 1.10 - 29.1, P ⫽ 0.04) was identified as an independent predictor of the presence of vascular lesions, and history of low-dose aspirin use (OR 6.00; 95% CI 1.13 - 31.9, P ⫽ 0.04) was identified as a predictor of the presence of erosive/ulcerated lesions. Conclusions: CE examination would be clinically meaningful for identifying the source of OGIB in CKD patients, especially patients with a history of recent blood transfusion and/or LDA use.
Forrest plots comparing complete enteroscopy rate and diagnostic yield between SBE and DBE.
Sa1638 A Meta-Analysis on Efficacy and Safety: Single-Balloon vs. Double-Balloon Enteroscopy Saurabh Sethi*, Douglas K. Pleskow, RAM Chuttani, Tyler M. Berzin, Mandeep Sawhney Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA Background: Double-balloon enteroscopy (DBE) and Single-balloon enteroscopy (SBE) are new techniques capable of deep enteroscopy. Results of individual studies comparing these two techniques have failed to identify a dominant strategy. Objectives: To systematically pool all available studies to compare the efficacy and safety of DBE with SBE for evaluation of the small bowel. Methods: Databases including PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched. Main outcome measures were complete smallbowel visualization, diagnostic yield, therapeutic yield, and complication rate. Statistical analysis was performed using Review Manager (RevMan version 5.0). Meta-analysis was performed using fixed effect or random-effect methods, depending on the absence or presence of significant heterogeneity. We used the 2 test to assess heterogeneity between trials and the I2 statistic to assess the extent of inconsistency. P ⬍ 0.05 was defined as significant heterogeneity. Results were expressed as OR or mean difference with 95% CI. P ⬍ 0.05 was considered statistically significant. Potential publication bias was examined by funnel plot. Results: Three prospective randomized controlled trials with a total of 268 patients were identified. DBE was superior to SBE for ability to visualize the entire small bowel (pooled OR⫽ 0.53 [95% CI: 0.28 to 0.98, p ⫽0.04). DBE was superior to SBE for ability to provide endoscopic therapy (pooled OR ⫽ 0.81 [95 % CI: 0.50 to 1.32, p⫽0.4). DBE and SBE were similar with regard to ability to provide diagnosis (pooled OR⫽ 0.44 [95 % CI: 0.23 to 0.83, p⫽ 0.01). There was no significant difference between DBE and SBE, with regard to complication rate (pooled OR 1.12 [95 % CI: 0.06 to 19.28, p⫽0.94). Conclusions: DBE was superior to SBE with regard to complete small bowel visualization and ability to provide treatment. DBE was similar to SBE with regard to diagnostic yield and complication rate.
Forrest plots comparing therapeutic yield and complication rate between SBE and DBE.
Sa1639 Is It Worth Pursuing Double Balloon Enteroscopy After Capsule Endoscopy in the Elderly? Findings From a Single Center Experience Victoria Gomez*, Michael J. Bartel, Mark E. Stark, Frank Lukens Gastroenterology, Mayo Clinic, Jacksonville, FL Introduction: The evaluation of obscure gastrointestinal bleeding and other suspected occult diseases of the small intestine involves use of capsule endoscopy (CE) and often times followed by double balloon enteroscopy (DBE). These two modalities are complimentary to each other with satisfactory diagnostic yield. However, DBE has procedureal related risks, and particularly in the very elderly patient population with naturally more co morbidities, has a presumed higher risk of adverse events. However, correlations between CE and DBE findings and overall outcomes of DBE are not well established in this older patient population. Aims: Primary aim was to determine the correlation between CE and DBE findings, followed by secondary aims of indications, findings and outcomes on DBE in the very elderly patient population defined by age ⬎⫽ 80 years. Methods: Review of a large prospectively collected DBE database from 2006 through November 2012. Patients’ demographics along with procedure indication, findings, and complications were recorded. The safety and diagnostic yield of DBE was calculated by frequency statistics. Correlation between findings on capsule endoscopy and DBE was analyzed. Results: During this study period, a total of 3100 DBE procedures were performed, for which 137 patients ⬎⫽ 80
AB276 GASTROINTESTINAL ENDOSCOPY Volume 77, No. 5S : 2013
www.giejournal.org
Abstracts
years of age (55.5% male) underwent a total of 223 DBE procedures (123 antegrade approach). The average age of these patients was 83.5 years (Range 80-94 years). Indications and findings are described in the Table. The most common DBE indication was occult gastrointestinal bleeding (66%). The most common finding was non-bleeding mucosal vascular ectasias (42.6%). A therapeutic intervention (other than diagnostic biopsies) was performed in 134 (60%) procedures. Of the 137 patient’s a total of 114 (83.2%) of these had a capsule endoscopy prior to DBE. Correlation between findings of capsule endoscopy and DBE occurred in 78.9% (see Table). The overall diagnostic (pertinent positive findings) yield of DBE was 89.2%. The diagnostic yield of DBE for gastrointestinal bleeding (occult and overt) was 90.2%. There were no immediate (less than 48 hours) post-procedural complications. Conclusion: Capsule endoscopy has a very high correlation with DBE, and furthermore, DBE can be performed safely in the octogenarian patient population. Given these findings, in an elderly patient with positive findings on CE, DBE should be considered as the next appropriate diagnostic and therapeutic test. Results of double balloon enteroscopy and correlation with capsule endoscopy Variable Indication Occult gastrointestinal bleeding Overt gastrointestinal bleeding Other Findings Nonbleeding vascular ectasia Normal Bleeding vascular ectasia Other Correlation between CE and DBE findings No correlation between CE and DBE findings False positive findings on CE False negative findings on CE
N encounters (%) 147 (66) 58 (26) 18 (8) 95 (42.6) 55 (24.7) 37 (16.6) 36 (16.1) 90/114 (78.9) 24/114 (21.1) 18 (75) 6 (25)
DBE⫽ double balloon enteroscopy. CE⫽ capsule endoscopy
Sa1640 Video Capsule Endoscopy and Double Balloon Enteroscopy in the Evaluation of Obscure Gastrointestinal Bleeding Bryan L. Balmadrid*1, Gulseren Seven1, Richard a. Kozarek1, Andrew S. Ross1, Shayan Irani1, Michael Gluck1, Drew B. Schembre2, Johannes Koch1, S. Ian Gan1 1 Gastroenterology, Virginia Mason Digestive Disease Institute, Seattle, WA; 2Gastroenterology, Swedish Medical Center, Seattle, WA Background: Double balloon enteroscopy (DBE) and video capsule endoscopies (VCE) have both been used in recent years in the evaluation of obscure GI bleed (OGIB). The studies are often complementary and most often performed sequentially, with VCE being performed first and DBE being performed thereafter. Objective: To determine if findings on VCE are predictive of findings at time of DBE and to determine the yield of DBE in VCE-negative patients. Secondary goal was to determine characteristics predictive of positive DBE. Methods: A single tertiary center retrospective database of all patients undergoing DBE between January 2006 and December 2012 was performed. Patients with a history of OGIB who had undergone VCE prior to DBE were identified and findings were compared. We evaluated the yield of DBE in comparison to VCE findings, and to identify patient characteristics that were associated with and increased likelihood of a positive DBE. Results: 177 patients with OGIB were identified. Of these, 148 underwent both VCE and DBE. The mean age was 65.2 years (range 15-94 y) and 55.4% were male. Overall, DBE found potential causes for OGIB in 51.4% compared to 61.1% for VCE. Most commonly identified sources of OGIB on either VCE or DBE were: blood (34.4%), arteriovenous malformations (AVM) (31.1%), ulcer or erosion (21.1%).58 patients had a normal VCE. In these patients, 29.3% (17) had an abnormal DBE with three most common small bowel (SB) findings being AVM (5), ulcer (4), submucosal lesion/polyp/tumor (4), and 2 findings outside of the SB (Cameron’s erosions, oozing left colon polyp). There were 124 abnormal VCE findings with 90 thought to be a potential cause of OGIB. Correlation with the DBE results was found in 41.5% (51). In 52% (64) there was no correlation and in 6.5% of patients (8) correlation was indeterminate. Positive VCE findings and negative VCE findings were associated with an OR of 3.79 (95% CI, 1.87 - 7.68) and OR of 0.26 (95% CI, 0.13 - 0.53), respectively, for positive DBE findings. Other characteristics that predicted positive DBE include: cardiovascular disease (OR 3.33 [95% CI, 1.79 - 6.20]), transfusion history (OR 1.95 [95% CI, 1.03 - 3.69]).DBE therapy was performed in 23.7%. ADBE was performed first in 74.0% compared to 26.0% for RDBE. ADBE was positive in 54.7% compared to 37.1% for RDBE. If a second DBE was performed after the first DBE, the yield was 55.6%. Conclusion: In patients with OGIB, findings on VCE are predictive of findings at DBE but correlation is lower than expected. Negative VCE does not preclude
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positive and treatable findings at DBE. Other characteristics associated with higher DBE yield include history of cardiovascular disease or transfusions. Repeat or reverse directional DBE performed after an initially negative DBE have relatively high yield rates.
Sa1641 Factors Associated With Negative Findings or No Therapy on Double Balloon Endoscopy in the Evaluation of Gastrointestinal Bleeding Hisham Hussan*1, Nicholas R. Crews4, Caroline M. Geremakis3, Soubhi Bahna2, Jennifer L. Labundy1, Christine Hachem1 1 Gastroenterology and Hepatology, Saint Louis University, Saint Louis, MO; 2Internal Medicine, Saint Louis University, Saint Louis, MO; 3 Center for Outcomes Research, Saint Louis University, Saint Louis, MO; 4School of Medicine, Saint Louis University, Saint Louis, MO Background: Obscure GI bleeding (OGIB) is a challenging diagnostic problem for gastroenterologists. Double balloon endoscopy (DBE) offers both diagnostic and therapeutic value in this setting. However, it is invasive, complex, and time-consuming. Aim: We conducted a retrospective study to identify variables associated with negative findings or non-therapeutic DBE performed for evaluating OGIB. Methods: Data were collected from patients who underwent DBE for evaluation of obscure gastrointestinal bleeding at Saint Louis University Hospital between August 1, 2010 and April 6, 2012. We classified DBE’s based on diagnostic findings and therapeutic outcomes. DBE’s were classified as “positive diagnostic” when potential bleeding sources (ulcers, polyps, masses, actively bleeding lesions) were found and correlated with video capsule endoscopy (VCE) findings. Positive therapeutic DBE’s were defined by performance of therapy during DBE to treat a bleeding source. Descriptive statistics, chi square, and logistic regression were conducted to identify demographic and clinical predictors of non-therapeutic or non-diagnostic DBE. Results: A total of 55 DBE were reviewed. Of those, 24 DBE had negative diagnostic findings and 30 DBE did not require therapy. The mean age of the sample was 67 with 32 males (58.2%).Univariate analyses are shown in the table below. In multivariate regression analysis a negative diagnostic DBE was associated with two or more DBE studies per day (OR: 13.72, p ⫽ 0.008) and no blood transfusions in the year prior to DBE (OR: 7.16, p ⫽ 0.03). Nontherapeutic DBE was associated with two or more DBE per day (OR: 18.579, p⫽0.007), a GI bleeding episode within the week prior to DBE (OR: 11.48, p⫽0.003) and blood transfusion requirements of less than or equal to 4 in the past 10 years prior to DBE (OR:4.55, p⫽0.036). Conclusion: Predictors of DBE findings and therapeutic intervention on DBE include ASA score, blood transfusion requirements, and previous findings on upper and lower endoscopy. Also, endoscopist fatigue may play a role in diagnostic and therapeutic yield of DBE in OGIB. More research is needed to optimize diagnostic and therapeutic outcomes in patients with OGIB. Univariate analysis of factors associated with negative diagnostic DBE and negative therapeutic DBE
Variables Pre-DBE ASA score ⱕ 2 Greater than one DBE in one day by single endoscopist GI bleed within 1 week prior to DBE Hgb of ⬎ 9 mg/dl prior to DBE Blood transfusions of less than 4 units in the 10 years prior to DBE No blood transfusions requirement in the year prior to DBE Prior EGD with no ulcers or AVMs Prior EGD and Colonoscopy with no ulcers or AVMs Prior enteroscopy with no AVMs
Negative diagnostic DBE p-value
No therapeutic intervention during DBE p-value
0.611 0.016
.044 0.024
0.179 0.010 0.149
0.010 0.035 0.027
0.019
0.044
0.031 ** 0.001 **
0.004 0.001
0.013
0.009
Fisher exact test **
Volume 77, No. 5S : 2013
GASTROINTESTINAL ENDOSCOPY
AB277