For small intestinal bleeding diagnosed by wireless capsule endoscopy (WCE): is push enteroscopoy still a viable option in regional hospitals.

Abstract

Background: Small intestine related bleeding constitute 5% of Gastrointestinal bleeding (GIB), of which about 50% secondary to angioectasia. The guidelines for investigation obscured GID suggests doing colonoscopy, gastroscopy then WCE if required. Then Balloon enteroscopy if a cause was found. Although it is a good modality but it’s not available to many regional hospitals and many patient prove reluctant to go for tertiary centers. The aim of our study is to explore whether using Push enteroscopy is still a viable option to treat some of those patients. Method: In a regional hospital with catchment area of 250,000, we collected the data over 15 months for patients who were referred for WCE to further investigate Iron deficiency anaemia after having gastroscopy and colonoscopy. Those with positive findings were either referred for Push enteroscopy (PE) if they have proximal lesions or balloon Enteroscopy (BE) if it was mid or distal lesion. Results: 51 patients, 22 female with median age of 65 years (31–91) were identified. The findings were 26 patients with angioectasia (AE) (51%) of them 10 had proximal lesions (38%). Other findings include normal (7), Gastrisits/Duodenitis (9), swollen mucosa/erythema (4), erosion (1), polyp (1) and incomplete study in (2). In the proximal AE group 7 were treated with PE and APC for a range of 5–20 AE. One treated patient was re-admitted with PR bleeding. In a follow up median of 9 months (5–13) only one of them re-admitted with heavy PR bleeding. 6/7 (86%) of them did not require any further Iron replacement. In the 3 other patients who had 1–2 AE with other pathology like diverticula it was thought that the AE is not the major cause and they were treated conservatively with Iron replacement. In the Mid/distalAE group 2 were referred for BE in tertiary hospital while the others continued on Iron replacement with few of them required IV Iron. 2 patients were admitted with PR bleeding. Conclusion: For Proximal SI lesion PE is a valid option to increase comfort and compliance of patient with physician recommendation and decrease the need for recurrent hospital admission for Iron infusion or prolonged oral Iron therapy.