Long-Term Outcomes After Double-Balloon Enteroscopy for Obscure Gastrointestinal Bleeding

Background & Aims: Long-term outcomes after double-balloon enteroscopy (DBE), performed for the evaluation of obscure gastrointestinal bleeding, have not been determined. Methods: We invited 274 patients undergoing DBE at Stanford University or the University of Chicago between 2004 and 2006 to participate in the study, 135 (49%) agreed (mean age, 64 +/- 14.8; range, 23-90 years). Telephone interviews were conducted at a mean of 11 and 30 months after DBE. Results: Arteriovenous malformations (AVMs) were detected in 43% of the cohort. One hundred one patients (37%; 56 with overt, 45 with occult bleeding) were interviewed 12 +/- 5 (range, 6-26) months after DBE. At 12 months, 43% reported no further overt bleeding or iron/transfusion needs, 23% reported overt bleeding, and 35% reported ongoing iron and/or transfusions. Eighty-five patients (31%) participated in the second survey, conducted 30 +/- 5.7 (range, 19-51) months after DBE. Fifty (59%) reported no overt bleeding or iron/transfusion needs, 20 (24%) reported overt bleeding, and 15 (18%) reported ongoing iron and/or transfusions. In the 40 patients evaluated after endoscopic treatment for AVMs, 17 (43%) reported no bleeding or iron therapy at 12 months and 16 of 29 (55%) at 30 months. Of the 40 patients with normal DBE examinations to the depth of insertion, 19 of 40 (48%) reported no bleeding or iron/transfusion needs at 12 months and 25 of 43 (58%) at 30 months. Conclusions: At 30 months after DBE, up to 60% of patients report no further bleeding. Patients with AVMs or normal examinations to the depth of insertion are most likely to report recurrent hemorrhage.