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False-negative double-balloon enteroscopy in overt small bowel bleeding: long-term follow-up after negative results

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Abstract

Background and aim

Double-balloon enteroscopy (DBE) performed to investigate overt small bowel bleeding can miss the source of bleeding. We investigated the clinical outcomes of patients with negative DBE results for suspected overt small bowel bleeding, which is defined in the current guidelines as obscure gastrointestinal bleeding.

Methods

We reviewed the prospectively collected medical records of patients who underwent DBE at our hospital between May 1, 2004 and April 30, 2016. During this period, 297 patients underwent DBE for suspected overt small bowel bleeding. The first DBE yielded negative results for 83 patients (27.9%). Written interviews, telephone interviews, and medical records of these patients were reviewed in April 2017. Follow-up data were collected for 63 patients (75.9%).

Results

During a mean follow-up period of 83.5 months, re-bleeding occurred in 21 of 63 patients (33.3%) after a mean of 23.0 months after the first DBE yielded negative results. The bleeding source was identified in 19 of 21 patients (90.5%). In 15 of these 19 patients (78.9%), the source was the small intestine. Among these 15 patients, 14 (93.3%) had bleeding sites within reach of the first DBE and 3 (20%) experienced their first incidence of re-bleeding more than 3 years after the first DBE. The need for transfusion for the first bleeding episode was a predictor of re-bleeding (odds ratio 7.5; 95% confidence interval 1.7–33.0).

Conclusions

False-negative DBE results for overt small bowel bleeding are not rare, and the first re-bleeding episode can occur 3 years later. Repeat DBE when re-bleeding occurs should be considered, even if the first DBE results were negative.

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Authors and Affiliations

  1. Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan

    Rintaro Hashimoto, Tomoki Matsuda & Masato Nakahori

  2. Division of Gastroenterology, University of California Irvine, 101 The City Drive, Bldg. 22C, Orange, CA, 92868, USA

    Rintaro Hashimoto

Authors
  1. Rintaro Hashimoto
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  2. Tomoki Matsuda
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  3. Masato Nakahori
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Contributions

Study conception and design: RH, TM, MN; Data analysis and interpretation: RH, TM; Drafting of the article: RH; Critical revision: TM, MN; Final approval of the article: TM.

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Correspondence to Rintaro Hashimoto.

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Disclosures

Drs. Rintaro Hashimoto, Tomoki Matsuda, and Masato Nakahori have no conflicts of interest or financial ties to disclose.

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Hashimoto, R., Matsuda, T. & Nakahori, M. False-negative double-balloon enteroscopy in overt small bowel bleeding: long-term follow-up after negative results. Surg Endosc 33, 2635–2641 (2019). https://doi.org/10.1007/s00464-018-6561-x

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  • DOI: https://doi.org/10.1007/s00464-018-6561-x

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