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Low rate of recurrent bleeding after double-balloon endoscopy-guided therapy in patients with overt obscure gastrointestinal bleeding

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Abstract

Background

Double-balloon endoscopy (DBE) provides both diagnosis and treatment in overt obscure gastrointestinal bleeding (OGIB). The aim of this study was to evaluate the rebleeding rate after DBE.

Methods

This retrospective review was conducted between January 2006 and July 2018, 166 patients with overt OGIB who underwent DBE were enrolled. Therapeutic intervention was defined as endoscopic treatment, embolization, or surgery. Primary outcome was rebleeding rate after DBE. The patients were divided into 3 groups based on their DBE; (1) positive DBE requiring therapeutic intervention (G1), (2) positive DBE without therapeutic intervention required (G2) and (3) negative DBE (G3). Cumulative incidence of rebleeding was estimated using the Kaplan–Meier method. Cox regression was used to assess the association of DBE with rebleeding risk. This study was approved by our Institutional Review Board.

Results

Sixty-eight patients (41%) were categorized in G1, 34 patients (20%) in G2 and 64 patients (39%) in G3. Overall rebleeding occurred in 24 patients (15%). The cumulative incidence of rebleeding for G1 was the lowest. The 1-year and 2-year cumulative probability of developing rebleeding after DBE in G1 were 3.5% and 3.5%, 8.2% and 14.0% in G2, and 18.2% and 20.6% in G3, respectively (p = 0.02). After adjusting for bleeding severity and comorbidities, patients with positive DBE requiring therapeutic intervention had a significantly lower rate of rebleeding when compared with patients who did not receive intervention (hazard ratio 0.17; 95% CI 0.03–0.90).

Conclusion

DBE-guided therapeutic intervention was associated with a lower risk of rebleeding when compared with those with negative and positive DBE without therapeutic intervention. One-fifth of patients with overt OGIB had false negative after DBE.

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Authors and Affiliations

  1. Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand

    Satimai Aniwan, Vichai Viriyautsahakul, Phonthep Angsuwatcharakon, Panida Piyachaturawat, Pradermchai Kongkam, Natanong Kongtab, Sombat Treeprasertsuk, Pinit Kullavanijaya & Rungsun Rerknimitr

  2. Division of General Internal Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand

    Thanawat Luangsukrerk

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  1. Satimai Aniwan
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  2. Vichai Viriyautsahakul
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  10. Rungsun Rerknimitr
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Corresponding author

Correspondence to Rungsun Rerknimitr.

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Disclosures

Drs. Satimai Aniwan, Vichai Viriyautsahakul, Thanawat Luangsukrerk, Phonthep Angsuwatcharakon, Panida Piyachaturawat, Pradermchai Kongkam, Sombat Treeprasertsuk, Pinit Kullavanijaya, Rungsun Rerknimitr and Ms. Natanong Kongtab have no conflicts of interest or financial ties to disclose.

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Aniwan, S., Viriyautsahakul, V., Luangsukrerk, T. et al. Low rate of recurrent bleeding after double-balloon endoscopy-guided therapy in patients with overt obscure gastrointestinal bleeding. Surg Endosc 35, 2119–2125 (2021). https://doi.org/10.1007/s00464-020-07615-3

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  • DOI: https://doi.org/10.1007/s00464-020-07615-3

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