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Double Balloon Enteroscopy Detects Small Bowel Mass Lesions Missed by Capsule Endoscopy

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Abstract

Background Small bowel mass lesions (SBML) are a relatively common cause of obscure gastrointestinal bleeding (OGIB). Their detection has been limited by the inability to endoscopically examine the entire small intestine. This has changed with the introduction of capsule endoscopy (CE) and double balloon enteroscopy (DBE) into clinical practice. Study Aim To evaluate the detection of SBML by DBE and CE in patients with OGIB who were found to have SBML by DBE and underwent both procedures. Methods A retrospective review of a prospectively collected database of all patients undergoing DBE for OGIB at seven North American tertiary centers was performed. Those patients who were found to have SBML as a cause of their OGIB were further analyzed. Results During an 18 month period, 183 patients underwent DBE for OGIB. A small bowel mass lesion was identified in 18 patients. Of these, 15 patients had prior CE. Capsule endoscopy identified the mass lesion in five patients; fresh luminal blood with no underlying lesion in seven patients, and non-specific erythema in three patients. Capsule endoscopy failed to identify all four cases of primary small bowel adenocarcinoma. Conclusions Double balloon enteroscopy detects small bowel mass lesions responsible for OGIB that are missed by CE. Additional endoscopic evaluation of the small bowel by DBE or intraoperative enteroscopy should be performed in patients with ongoing OGIB and negative or non-specific findings on CE.

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Authors and Affiliations

  1. The University of Chicago, Chicago, USA

    Andrew Ross, Irving Waxman, Charles Dye & Carol Semrad

  2. Virginia Mason Medical Center, 1100 9th Ave., Mail Stop C3-GAS, Seattle, WA, 98111, USA

    Andrew Ross

  3. Cedars-Sinai Medical Center, Los-Angeles, USA

    Shahab Mehdizadeh, Gary Chen & Simon Lo

  4. Fox Chase Cancer Center, Philadelphia, USA

    Jeffrey Tokar & Oleh Haluszka

  5. Mayo Clinic Scottsdale, Rochester, USA

    Jonathan A. Leighton & M. Edwyn Harrison

  6. Stanford University, Stanford, USA

    Ahmad Kamal & Lauren Gerson

  7. California Pacific Medical Center, San Francisco, USA

    Ann Chen & Kenneth Binmoeller

  8. Virginia Mason Medical Center, Seattle, USA

    Drew Schembre & Richard Kozarek

Authors
  1. Andrew Ross
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  2. Shahab Mehdizadeh
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  3. Jeffrey Tokar
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  4. Jonathan A. Leighton
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  5. Ahmad Kamal
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  6. Ann Chen
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  7. Drew Schembre
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  8. Gary Chen
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  9. Kenneth Binmoeller
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  10. Richard Kozarek
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  11. Irving Waxman
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  12. Charles Dye
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  13. Lauren Gerson
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  14. M. Edwyn Harrison
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  15. Oleh Haluszka
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  16. Simon Lo
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Correspondence to Andrew Ross.

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Ross, A., Mehdizadeh, S., Tokar, J. et al. Double Balloon Enteroscopy Detects Small Bowel Mass Lesions Missed by Capsule Endoscopy. Dig Dis Sci 53, 2140–2143 (2008). https://doi.org/10.1007/s10620-007-0110-0

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  • DOI: https://doi.org/10.1007/s10620-007-0110-0

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