EFFECTIVENESS OF ENDOTHERAPY OF SMALL BOWEL ANGIOECTASIAS WITH ARGON PLASMA COAGULATION (APC) THROUGH DOUBLE-BALLOON ENTEROSCOPY (DBE)

2020 ◽  
Author(s):  
E Vlachou ◽  
S Goggaki ◽  
A Theophanopoulou ◽  
K Toumpelis ◽  
L Petrogiannopoulos ◽  
...  
Keyword(s):  
Small Bowel ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Double Balloon Enteroscopy ◽  
Balloon Enteroscopy ◽  
Plasma Coagulation ◽  
Double Balloon

Refractory Anaemia Secondary to Small Bowel Angioectasias - Comparison between Endotherapy Alone versus Combination with Somatostatin Analogues

2017 ◽  
Vol 26 (4) ◽  
pp. 369-374 ◽  
Author(s):  
Stefania Chetcuti Zammit ◽  
Reena Sidhu ◽  
David Sanders
Keyword(s):  
Small Bowel ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Additional Treatment ◽  
Double Balloon Enteroscopy ◽  
Balloon Enteroscopy ◽  
Plasma Coagulation ◽  
Double Balloon ◽  
Group 2 ◽  
Group 1

Background & Aims: Patients with small bowel angioectasias (SBAs) can be difficult to manage as they are generally elderly with multiple co-morbidities. Angioectasias are multiple and tend to recur. Argon plasma coagulation (APC), despite being a commonly used method to treat these patients has an associated persistent rate of re-bleeding necessitating additional treatment to manage these patients.Methods: All patients with refractory iron deficiency anaemia secondary to SBAs were retrospectively subdivided into two groups. Patients in group 1 were managed with double balloon enteroscopy (DBE) and APC alone and those in group 2 received Lanreotide in addition to DBE and APC.Results: A total of 49 patients were included in this study: group 1: 37 patients (75.5%), group 2: 12 patients (24.5%). All had significant comorbidities and the mean duration of anaemia was 114.3, SD 307.0 months. Significant improvements in haemoglobin (Hb) (11g/L vs 3.2g/L p=0.043), transfusion requirements per month (0.8 vs 4.7 p=0.052) and mean bleeding episodes (1.08 vs 2.6 p=0.032) were demonstrated in group 2 when compared to group 1. One patient developed symptomatic gallstone disease and one patient stopped Lanreotide due to a lack of response.Conclusions: This is the first study comparing endotherapy to a combination of endotherapy and pharmacotherapy. It shows a significantly better outcome in patients receiving a combination of endotherapy and Lanreotide. Lanreotide can be a safe additional treatment in patients not responding to APC alone.Abbreviations: APC: argon plasma coagulation; CE: capsule endoscopy; DBE double balloon enteroscopy; Hb: hemoglobin; OGIB: over gastrointestinal bleeding; SBAs: small bowel angioectasias.

scholarly journals Double-Balloon Enteroscopy following Capsule Endoscopy in the Management of Obscure Gastrointestinal Bleeding: Outcome of a Combined Approach

2008 ◽  
Vol 22 (5) ◽  
pp. 491-495 ◽  
Author(s):  
Patarapong Kamalaporn ◽  
Sarah Cho ◽  
Nancy Basset ◽  
Maria Cirocco ◽  
Gary May ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Capsule Endoscopy ◽  
Therapeutic Intervention ◽  
Argon Plasma Coagulation ◽  
Argon Plasma ◽  
Obscure Gastrointestinal Bleeding ◽  
Double Balloon Enteroscopy ◽  
Balloon Enteroscopy ◽  
Plasma Coagulation ◽  
Double Balloon

BACKGROUND: There is no consensus on the relative accuracy of capsule endoscopy (CE) versus double-balloon enteroscopy (DBE) to investigate obscure gastrointestinal bleeding (GIB). CE is less invasive, but DBE more directly examines the small bowel, and allows tissue sampling plus therapeutic intervention.OBJECTIVES: To evaluate the yield and outcome of DBE following CE in patients with obscure GIB.METHODS: After DBE became readily available at the Centre for Therapeutic Endoscopy and Endoscopic Oncology (St Michael’s Hospital, Toronto, Ontario), all patients with obscure GIB seen from December 2002 to June 2007 were evaluated identically, first with CE, then with DBE (some with further interventions). Findings, adverse outcomes and interventions are reported.RESULTS: Fifty-one patients (25 women) with a mean (range) age of 64.1 years (34 to 83 years) are reported. Eight patients underwent DBE twice, for a total of 59 DBEs. Fourteen patients had overt GIB and the median (range) number of red blood cell unit transfusions was 10 (0 to 100). The positive findings for each type of lesion were compared in these 51 patients: angiodysplasia (CE 64.7% and DBE 61%, P=0.3), ulcers (CE 19.6% and DBE 18.6%, P=0.5), bleeding lesions (CE 43.1% and DBE 15.3%, P=0.0004) and mass (CE 10.2% and DBE 8.5%, P=0.5). DBE provided the advantage of therapeutic intervention: argon plasma coagulation (33 of 59 DBEs), clipping (two of 59), both argon plasma coagulation and clipping (three of 59), polypectomy (two of 59), tattooing (52 of 59) and biopsies (11 of 59). DBE detected lesions not seen by CE in 21 patients; lesions were treated in 18 patients. However, CE detected 31 lesions not seen by DBE. No major complications occurred with either examination.CONCLUSION: Overall detection rates for both techniques are similar. Each technique detected lesions not seen by the other. These data suggest that CE and DBE are complementary and that both evaluate obscure GIB more fully than either modality alone.

Double-Balloon Enteroscopy-detected Lipid Islets in the Small Bowel are Strong Predictors of Cardiovascular Disease when associated with Angiectasia and Bleeding

2016 ◽  
Vol 25 (1) ◽  
pp. 33-37 ◽  
Author(s):  
Heinz Albrecht ◽  
Wolfgang H. Hagel ◽  
Alexander F. Hagel ◽  
Markus F. Neurath ◽  
Martin Raithel
Keyword(s):  
Cardiovascular Disease ◽  
Small Bowel ◽  
Gastrointestinal Bleeding ◽  
Diagnostic Yield ◽  
Argon Plasma Coagulation ◽  
Bleeding Event ◽  
Safe Procedure ◽  
Double Balloon Enteroscopy ◽  
Balloon Enteroscopy ◽  
Double Balloon

Background & Aims: Double-balloon enteroscopy (DBE) is a sensitive and safe procedure for the detection and treatment of mid-gastrointestinal bleeding (MGIB). It combines the possibility of a panenteroscopy with the immediate chance for intervention. This study evaluates the yield of DBE for the detection and treatment of MGIB in an unselected patient cohort. Methods: In a five-year period a total of 119 DBEs were carried out on 62 patients due to MGIB. Inclusion criteria were hematochezia, melena, anemia, positive hemoccult-test and iron deficiency. All pre-existing diseases or comorbidities were evaluated. Two main statistical methodologies were used in data analysis: descriptive statistics to describe the basic features of our data and Fisher’s exact test for comparisons of proportions. Results: The diagnostic yield was 69% (pathological findings in 43/62 patients) and the main diagnoses in all DBE-procedures were angiodysplasia (22%, 26/119 DBE), followed by lipid islets (18%, 21/119 DBE). In all patients with lipid islets this diagnosis was significantly connected with cardiovascular diseases. The combination of lipid islets and a relevant bleeding source appeared in 79% of the 19 patients with these findings. Of these, 53% had to be treated due to the bleeding event. The overall therapeutic intervention rate was 58%. Serious complications such as perforation or pancreatitis did not occur. Conclusion: Double-balloon enteroscopy as the gold standard for small bowel investigation in MGIB confirmed its high diagnostic yield in an unselected cohort of patients. A new strong combination of lipid islets with cardiovascular disease was revealed, with a high incidence of angiectasia bleeding. This combination should be evaluated in more detail as a new risk factor for MGIB, and should be regarded in this population when therapeutic anticoagulation is needed. Abbreviations: APC: argon plasma coagulation; CE: capsule endoscopy; DBE: double-balloon enteroscopy; EGD: esophagogastroduodenoscopy; ERCP: endoscopic retrograde cholangio-pancreatography; MGIB: mid-gastrointestinal bleeding; OGIB: obscure gastrointestinal bleeding; PE: push enteroscopy.

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