Incidence of bleeding lesions within reach of conventional upper and lower endoscopes in patients undergoing double-balloon enteroscopy for obscure gastrointestinal bleeding

Background Double-balloon enteroscopy (DBE) is a useful method for evaluation of obscure gastrointestinal bleeding (OGIB). Aim To determine the incidence of lesions within reach of conventional upper and lower endoscopes as the cause of OGIB in patients referred for DBE. Methods All patients undergoing DBE for OGIB during a 3.5-year period at a university hospital were studied. OGIB was defined according to American Gastroenterological Association (AGA) guidelines. Results One hundred and forty-three DBEs were performed in 107 patients for obscure overt (n = 85) and obscure occult (n = 22) GIB. Lesions outside the SB as possible sources of GIB were found in 51 patients (47.6%) and a definite source of bleeding outside the small bowel (SB) was detected in 26 patients (24.3%). Lesions considered to explain a definite source of GIB were: gastric ulcer (n = 3), duodenal ulcer (n = 3), Cameron's lesions (n = 2), gastric antral vascular ectasias (n = 4), radiation proctitis (n = 1), radiation ileitis (n = 2), duodenal angiodysplasias (n = 1), haemorrhoids with stigmata of recent bleed (n = 1), colon angiodysplasias (n = 3), colon diverticulosis (n = 3), colonic Crohn's disease (n = 1), anastomotic ulcers (n = 1). Conclusions The frequency of non-SB lesions definitely explaining the source of GIB in patients referred for DBE was 24.3%. Therefore, repeat esophago-gastroduodenoscopy (EGD) and ileocolonoscopy should be taken into consideration before DBE.