Advertisement
Digestive Endoscopy| Volume 54, ISSUE 2, P251-257, February 2022

Download started.

Ok

Clinical impact of videocapsule and double balloon enteroscopy on small bowel bleeding: Results from a large monocentric cohort in the last 19 years

  • Luca Elli
    Correspondence
    Corresponding author at: Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20131, Italy.
    Affiliations
    Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20131, Italy

    Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
    Search for articles by this author
  • Lucia Scaramella
    Affiliations
    Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20131, Italy

    Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
    Search for articles by this author
  • Gian Eugenio Tontini
    Affiliations
    Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20131, Italy

    Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
    Search for articles by this author
  • Matilde Topa
    Affiliations
    Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20131, Italy

    Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
    Search for articles by this author
  • Dario Conte
    Affiliations
    Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20131, Italy
    Search for articles by this author
  • Reena Sidhu
    Affiliations
    Royal Hallamshire Hospital, Sheffield, UK
    Search for articles by this author
  • Emanuele Rondonotti
    Affiliations
    Unit of Gastroenterology, Valduce Hospital, Como, Italy
    Search for articles by this author
  • Roberto Penagini
    Affiliations
    Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20131, Italy

    Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
    Search for articles by this author
  • Maurizio Vecchi
    Affiliations
    Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20131, Italy

    Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
    Search for articles by this author
Published:August 07, 2021DOI:https://doi.org/10.1016/j.dld.2021.07.014

      Abstract

      Background

      Suspected small bowel bleeding (SSBB) is the main indication for videocapsule endoscopy (VCE) and double balloon enteroscopy (DBE). We assessed the impact of both modalities in a large cohort of SSBB patients in a European tertiary center.

      Methods

      We retrospectively evaluated consecutive patients with SSBB undergoing VCE and/or DBE from March 2001 to July 2020. Demographic/clinical parameters, anticoagulant therapies, technical characteristics and adverse events were collected, as well as diagnostic yield (DY), VCE–DBE concordance, hemoglobin (Hb) values before and after DBE, and complications.

      Results

      807 VCEs and 407 DBEs were performed in 751 patients. The DY was significantly higher in DBE compared with VCE (68.8% vs 57.7%), with the highest (75%) yield for overt active SB bleeding. The agreement between VCE and DBE was generally suboptimal (k = 0.059). This improved in cases where both procedures were done within 1–5 days of the other (k = 0.323). Post-procedural Hb values were significantly higher. In patients treated with direct oral anticoagulants (DOACs), there were no differences in DY, complications or Hb values compared with non-DOAC patients.

      Conclusion

      VCE and DBE play a pivotal role in the diagnostic and therapeutic approach to SSBB, having a high clinical impact even in patients treated with DOACs.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Digestive and Liver Disease
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Yamamoto H.
        • Sekine Y.
        • Sato Y.
        • Higashizawa T.
        • Miyata T.
        • Iino S.
        • et al.
        Total enteroscopy with a nonsurgical steerable double-balloon method.
        Gastrointest Endosc. 2001; 53: 216-220https://doi.org/10.1067/mge.2001.112181
        • Kaffes A.J.
        Advances in modern enteroscopy therapeutics.
        Best Pract Res Clin Gastroenterol. 2012; 26: 235-246https://doi.org/10.1016/j.bpg.2012.03.011
        • Rondonotti E.
        • Spada C.
        • Adler S.
        • May A.
        • Despott E.J.
        • Koulaouzidis A.
        • et al.
        Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders.
        Eur Soc Gastrointest Endosc (ESGE) Tech Rev Endosc. 2018; 50: 423-446https://doi.org/10.1055/a-0576-0566
        • Yamamoto H.
        • Ogata H.
        • Matsumoto T.
        • Ohmiya N.
        • Ohtsuka K.
        • Watanabe K.
        • et al.
        Clinical practice guideline for enteroscopy.
        Dig Endosc. 2017; 29: 519-546https://doi.org/10.1111/den.12883
        • Elli L.
        • Norsa L.
        • Zullo A.
        • Carroccio A.
        • Girelli C.
        • Oliva S.
        • et al.
        Diagnosis of chronic anaemia in gastrointestinal disorders: a guideline by the Italian association of Hospital Gastroenterologists and endoscopists (AIGO) and the Italian Society of Paediatric Gastroenterology Hepatology and nutrition (SIGENP).
        Dig Liver Dis. 2019; 51: 471-483https://doi.org/10.1016/j.dld.2019.01.022
        • Tontini G.E.
        • Manfredi G.
        • Orlando S.
        • Neumann H.
        • Vecchi M.
        • Buscarini E.
        • et al.
        Endoscopic ultrasonography and small-bowel endoscopy: present and future.
        Dig Endosc. 2019; 31: 627-643https://doi.org/10.1111/den.13429
        • Otani K.
        • Watanabe T.
        • Shimada S.
        • Hosomi S.
        • Nagami Y.
        • Tanaka F.
        • et al.
        Clinical utility of capsule endoscopy and double-balloon enteroscopy in the management of obscure gastrointestinal bleeding.
        Digestion. 2018; 97: 52-58https://doi.org/10.1159/000484218
        • Chetcuti Zammit S.
        • Sanders D.S.
        • McAlindon M.E.
        • Sidhu R.
        Optimising the use of small bowel endoscopy: a practical guide.
        Frontline Gastroenterol. 2019; 10: 171-176https://doi.org/10.1136/flgastro-2018-101077
        • Rondonotti E.
        • Paggi S.
        Videocapsule endoscopy in celiac disease: indications and timing.
        Dig Dis. 2015; 33: 244-251https://doi.org/10.1159/000369510
        • Pennazio M.
        • Spada C.
        • Eliakim R.
        • Keuchel M.
        • May A.
        • Mulder C.J.
        • et al.
        Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European society of gastrointestinal endoscopy (ESGE) clinical guideline.
        Endoscopy. 2015; 47: 352-376https://doi.org/10.1055/s-0034-1391855
        • Gerson L.B.
        • Fidler J.L.
        • Cave D.R.
        • Leighton J.A.
        ACG clinical guideline: diagnosis and management of small bowel bleeding.
        Am J Gastroenterol. 2015; 110: 1265-1287https://doi.org/10.1038/ajg.2015.246
        • Cotton P.B.
        • Eisen G.M.
        • Aabakken L.
        • Baron T.H.
        • Hutter M.M.
        • Jacobson B.C.
        • et al.
        A lexicon for endoscopic adverse events: report of an ASGE workshop.
        Gastrointest Endosc. 2010; 71: 446-454https://doi.org/10.1016/j.gie.2009.10.027
        • Kita H.
        • Yamamoto H.
        • Nakamura T.
        • Shirakawa K.
        • Terano A.
        • Sugano K.
        Bleeding polyp in the mid small intestine identified by capsule endoscopy and treated by double-balloon endoscopy.
        Gastrointest Endosc. 2005; 61: 628-629
        • Kita H.
        • Yamamoto H.
        New indications of double balloon endoscopy.
        Gastrointest Endosc. 2007; 66: S57-S59https://doi.org/10.1016/j.gie.2007.03.1038
        • Kuno A.
        • Yamamoto H.
        • Kita H.
        • Sunada K.
        • Yano T.
        • Hayashi Y.
        • et al.
        Double-balloon enteroscopy through a Roux-en-Y anastomosis for EMR of an early carcinoma in the afferent duodenal limb.
        Gastrointest Endosc. 2004; 60: 1032-1034
        • Nishimura M.
        • Yamamoto H.
        • Kita H.
        • Yano T.
        • Sunada K.
        • Miyata T.
        • et al.
        Gastrointestinal stromal tumor in the jejunum: diagnosis and control of bleeding with electrocoagulation by using double-balloon enteroscopy.
        J Gastroenterol. 2004; 39: 1001-1004https://doi.org/10.1007/s00535-004-1434-6
        • Ohmiya N.
        • Taguchi A.
        • Shirai K.
        • Mabuchi N.
        • Arakawa D.
        • Kanazawa H.
        • et al.
        Endoscopic resection of Peutz-Jeghers polyps throughout the small intestine at double-balloon enteroscopy without laparotomy.
        Gastrointest Endosc. 2005; 61: 140-147
        • Sunada K.
        • Yamamoto H.
        • Kita H.
        • Yano T.
        • Sato H.
        • Hayashi Y.
        • et al.
        Clinical outcomes of enteroscopy using the double-balloon method for strictures of the small intestine.
        World J Gastroenterol. 2005; 11: 1087-1089https://doi.org/10.3748/wjg.v11.i7.1087
        • Shah R.J.
        • Smolkin M.
        • Yen R.
        • Ross A.
        • Kozarek R.A.
        • Howell D.A.
        • et al.
        A multicenter, U.S. experience of single-balloon, double-balloon, and rotational overtube-assisted enteroscopy ERCP in patients with surgically altered pancreaticobiliary anatomy (with video).
        Gastrointest Endosc. 2013; 77: 593-600https://doi.org/10.1016/j.gie.2012.10.015
        • Liao Z.
        • Gao R.
        • Xu C.
        • Li Z.-S.
        Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review.
        Gastrointest Endosc. 2010; 71: 280-286https://doi.org/10.1016/j.gie.2009.09.031
        • Wang D.
        • Hu B.
        • Hu C.
        • Zhu F.
        • Liu X.
        • Zhang J.
        • et al.
        Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China.
        JAMA. 2020; 323: 1061-1069https://doi.org/10.1001/jama.2020.1585
        • Pasha S.F.
        • Leighton J.A.
        Evidence-based guide on capsule endoscopy for small bowel bleeding.
        Gastroenterol Hepatol. 2017; 13 (N Y): 88-93
        • Teshima C.W.
        • Kuipers E.J.
        • van Zanten S.V.
        • Mensink P.B.F.
        Double balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding: an updated meta-analysis.
        J Gastroenterol Hepatol. 2011; 26: 796-801https://doi.org/10.1111/j.1440-1746.2010.06530.x
        • Pasha S.F.
        • Leighton J.A.
        • Das A.
        • Harrison M.E.
        • Decker G.A.
        • Fleischer D.E.
        • et al.
        Double-balloon enteroscopy and capsule endoscopy have comparable diagnostic yield in small-bowel disease: a meta-analysis.
        Clin Gastroenterol Hepatol. 2008; 6: 671-676https://doi.org/10.1016/j.cgh.2008.01.005
        • Leighton J.A.
        • Triester S.L.
        • Sharma V.K.
        Capsule endoscopy: a meta-analysis for use with obscure gastrointestinal bleeding and Crohn's disease.
        Gastrointest Endosc Clin N Am. 2006; 16: 229-250https://doi.org/10.1016/J.GIEC.2006.03.004
        • Mylonaki M.
        • Fritscher-Ravens A.
        • Swain P.
        Wireless capsule endoscopy: a comparison with push enteroscopy in patients with gastroscopy and colonoscopy negative gastrointestinal bleeding.
        Gut. 2003; 52: 1122-1126https://doi.org/10.1136/gut.52.8.1122
        • Brito H.P.
        • Ribeiro I.B.
        • de Moura D.T.H.
        • Bernardo W.M.
        • Chaves D.M.
        • Kuga R.
        • et al.
        Video capsule endoscopy vs double-balloon enteroscopy in the diagnosis of small bowel bleeding: a systematic review and meta-analysis.
        World J Gastrointest Endosc. 2018; 10: 400-421https://doi.org/10.4253/wjge.v10.i12.400
        • Xin L.
        • Liao Z.
        • Jiang Y.P.
        • Li Z.S.
        Indications, detectability, positive findings, total enteroscopy, and complications of diagnostic double-balloon endoscopy: a systematic review of data over the first decade of use.
        Gastrointest Endosc. 2011; 74: 563-570https://doi.org/10.1016/j.gie.2011.03.1239
        • Ohmiya N.
        • Yano T.
        • Yamamoto H.
        • Arakawa D.
        • Nakamura M.
        • Honda W.
        • et al.
        Diagnosis and treatment of obscure GI bleeding at double balloon endoscopy.
        Gastrointest Endosc. 2007; 66: S72-S77https://doi.org/10.1016/j.gie.2007.05.041
        • Cangemi D.J.
        • Patel M.K.
        • Gomez V.
        • Cangemi J.R.
        • Stark M.E.
        • Lukens F.J.
        Small bowel tumors discovered during double-balloon enteroscopy: analysis of a large prospectively collected single-center database.
        J Clin Gastroenterol. 2013; 47: 769-772https://doi.org/10.1097/MCG.0b013e318281a44e
        • Zhong J.
        • Ma T.
        • Zhang C.
        • Sun B.
        • Chen S.
        • Cao Y.
        • et al.
        A retrospective study of the application on double-balloon enteroscopy in 378 patients with suspected small-bowel diseases.
        Endoscopy. 2007; 39: 208-215https://doi.org/10.1055/s-2007-966190
        • Arakawa D.
        • Ohmiya N.
        • Nakamura M.
        • Honda W.
        • Shirai O.
        • Itoh A.
        • et al.
        Outcome after enteroscopy for patients with obscure GI bleeding: diagnostic comparison between double-balloon endoscopy and videocapsule endoscopy.
        Gastrointest Endosc. 2009; 69: 866-874https://doi.org/10.1016/j.gie.2008.06.008
        • Ruff C.T.
        • Giugliano R.P.
        • Braunwald E.
        • Hoffman E.B.
        • Deenadayalu N.
        • Ezekowitz M.D.
        • et al.
        Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials.
        Lancet. 2014; 383: 955-962https://doi.org/10.1016/S0140-6736(13)62343-0
        • Yamaoka M.
        • Imaeda H.
        • Hosoe N.
        • Yoneno K.
        • Kanno R.
        • Mitsufuji T.
        • et al.
        Small-bowel lesions in patients taking direct oral anticoagulants detected using capsule endoscopy.
        Gastroenterol Res Pract. 2020; 20207125642https://doi.org/10.1155/2020/7125642
        • Tontini G.E.
        • Wiedbrauck F.
        • Cavallaro F.
        • Koulaouzidis A.
        • Marino R.
        • Pastorelli L.
        • et al.
        Small-bowel capsule endoscopy with panoramic view: results of the first multicenter, observational study (with videos).
        Gastrointest Endosc. 2017; 85 (e2): 401-408https://doi.org/10.1016/j.gie.2016.07.063
        • Saurin J.C.
        • Delvaux M.
        • Gaudin J.L.
        • Fassler I.
        • Villarejo J.
        • Vahedi K.
        • et al.
        Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding: blinded comparison with video push-enteroscopy.
        Endoscopy. 2003; 35: 576-584https://doi.org/10.1055/s-2003-40244
        • Höög C.M.
        • Bark L.-Å.
        • Arkani J.
        • Gorsetman J.
        • Broström O.
        • Sjöqvist U.
        Capsule retentions and incomplete capsule endoscopy examinations: an analysis of 2300 examinations.
        Gastroenterol Res Pract. 2012; 2012518718https://doi.org/10.1155/2012/518718
        • Di Caro S.
        • May A.
        • Heine D.G.N.
        • Fini L.
        • Landi B.
        • Petruzziello L.
        • et al.
        The European experience with double-balloon enteroscopy: indications, methodology, safety, and clinical impact.
        Gastrointest Endosc. 2005; 62: 545-550https://doi.org/10.1016/j.gie.2005.04.029
        • Lenz P.
        • Domagk D.
        Double- vs. single-balloon vs. spiral enteroscopy.
        Best Pract Res Clin Gastroenterol. 2012; 26: 303-313https://doi.org/10.1016/j.bpg.2012.01.021
        • Gross S.A.
        • Stark M.E.
        Initial experience with double-balloon enteroscopy at a U.S. center.
        Gastrointest Endosc. 2008; 67: 890-897https://doi.org/10.1016/j.gie.2007.07.047
        • Tanaka S.
        • Mitsui K.
        • Yamada Y.
        • Ehara A.
        • Kobayashi T.
        • Seo T.
        • et al.
        Diagnostic yield of double-balloon endoscopy in patients with obscure GI bleeding.
        Gastrointest Endosc. 2008; 68: 683-691https://doi.org/10.1016/j.gie.2008.03.1062
        • Kakiya Y.
        • Shiba M.
        • Okamoto J.
        • Kato K.
        • Minamino H.
        • Ominami M.
        • et al.
        A comparison between capsule endoscopy and double balloon enteroscopy using propensity score-matching analysis in patients with previous obscure gastrointestinal bleeding.
        Scand J Gastroenterol. 2017; 52: 306-311https://doi.org/10.1080/00365521.2016.1253766
        • Hadithi M.
        • Heine G.D.N.
        • Jacobs M.A.J.M.
        • van Bodegraven A.A.
        • Mulder C.J.J.
        A prospective study comparing video capsule endoscopy with double-balloon enteroscopy in patients with obscure gastrointestinal bleeding.
        Am J Gastroenterol. 2006; 101: 52-57https://doi.org/10.1111/j.1572-0241.2005.00346.x
        • Pennazio M.
        • Santucci R.
        • Rondonotti E.
        • Abbiati C.
        • Beccari G.
        • Rossini F.P.
        • et al.
        Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy: report of 100 consecutive cases.
        Gastroenterology. 2004; 126: 643-653
        • Carey E.J.
        • Leighton J.A.
        • Heigh R.I.
        • Shiff A.D.
        • Sharma V.K.
        • Post J.K.
        • et al.
        A single-center experience of 260 consecutive patients undergoing capsule endoscopy for obscure gastrointestinal bleeding.
        Am J Gastroenterol. 2007; 102: 89-95https://doi.org/10.1111/j.1572-0241.2006.00941.x
        • Chetcuti Zammit S.
        • Sanders D.S.
        • Sidhu R.
        Device assisted enteroscopy in the elderly-a systematic review and meta-analysis.
        Dig Liver Dis. 2019; 51: 1249-1256https://doi.org/10.1016/j.dld.2019.04.001
        • Bonnet S.
        • Douard R.
        • Malamut G.
        • Cellier C.
        • Wind P.
        Intraoperative enteroscopy in the management of obscure gastrointestinal bleeding.
        Dig Liver Dis. 2013; 45: 277-284https://doi.org/10.1016/j.dld.2012.07.003
        • Raju S.A.
        • Ching H.-L.
        • Branchi F.
        • Yung D.E.
        • Koulaouzidis A.
        • Plevris J.N.
        • et al.
        Multicentre European study of double balloon enteroscopy for small bowel pathology in patients with cardiovascular disease.
        Expert Rev Gastroenterol Hepatol. 2017; 11: 391-392https://doi.org/10.1080/17474124.2017.1301598