Long-Term Outcome of Patients Treated With Double Balloon Enteroscopy for Small Bowel Vascular Lesions

• Published in: The American journal of gastroenterology Vol. 107; no. 2; pp. 240 - 246
• Main Authors: SAMAHA, E, RAHMI, G, LANDI, B, LORENCEAU-SAVALE, C, MALAMUT, G, CANARD, J.-M, BLOCH, F, JIAN, R, CHATELLIER, G, CELLIER, C
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01-02-2012; Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Digestive system. Abdomen; Double-Balloon Enteroscopy; Endoscopy; Female; Follow-Up Studies; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Hemorrhage - surgery; Humans; Intestinal Diseases - surgery; Intestine, Small - surgery; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Retrospective Studies; Treatment Outcome; Human; Prognosis; Treatment; Double balloon enteroscopy; Blood vessel; Gastroenterology; Lesion; Small intestine; Long term
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1038/ajg.2011.325

Early rebleeding rate after endoscopic therapy with double balloon enteroscopy (DBE) of hemorrhagic small bowel vascular lesions (SBVL) varies between 10 and 50%. In recent reports, long-term follow-up of patients have been described but rebleeding risk factors are still not well established. The aim of the current study was to identify long-term treatment success rate and rebleeding risk factors after DBE therapy in a large cohort.
We conducted a single-center, retrospective cohort study in a large French tertiary-referral center between January 2004 and December 2007.
Among 261 patients presenting with obscure gastrointestinal bleeding (OGIB), SBVL was present in 133 patients and was treated successfully in 129 (97%) using mainly argon plasma coagulation. Ninety-eight patients were followed up for a mean period of 22.6±13.9 months (range 1-52). Rebleeding rate was 46% (45/98 patients) at 36 months. On multivariate analysis, the total number of observed lesions (hazard ratio (HR): 1.15, 95% confidence interval (CI): 1.06-1.25, P=0.001) and the presence of a valvular and/or arrhythmic cardiac disease (HR: 2.50, 95% CI: 1.29-4.87, P=0.007) were significantly associated with the risk of rebleeding. Complication rate of therapeutic DBE was 2.3% with no mortality.
Endoscopic therapy using DBE for SBVL in patients with recurrent OGIB allows a long-term remission in more than half of the patients. Independent rebleeding risk factors after a first endoscopic therapy are an increased number of SBVL and an associated valvular/arrhythmic heart disease.