Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Study reports Double Balloon Endoscopy useful for diagnosis and treatment of obscure GI bleeding

03.11.2008
Best when performed proximate to the bleeding event

A study by researchers in Japan concludes that Double Balloon Endoscopy™ (DBE) was very useful in the diagnosis of obscure gastrointestinal (GI) bleeding and had a therapeutic impact on the majority of patients. The study appears in the October issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE).

Endoscopy is a procedure that uses an endoscope - a thin, flexible tube with a light and a lens on the end to look into the esophagus, stomach, duodenum, small intestine, colon, or rectum, in order to diagnose or treat a condition. There are many types of endoscopy, including colonoscopy, sigmoidoscopy, gastroscopy, enteroscopy, and esophogogastroduodenoscopy (EGD). Capsule endoscopy (CE) uses a pill- sized video capsule, which has its own lens and light source that the patient swallows for examination of the small intestine.

The balloon assisted enteroscopy technique is a new method that advances the scope through the small intestine by inflating and deflating balloons, and pleats the small bowel over a tube like a curtain rod. This technique allows for diagnosis and treatment of small intestinal disorders. Balloon assisted enteroscopy can be performed with one or two balloons. When two balloons are used, the technique is referred to as Double Balloon Endoscopy™.

"The source of GI bleeding can be identified in most cases by conventional upper-GI and lower-GI endoscopy, but approximately five percent of all GI bleeding remains undiagnosed," said study lead author Shu Tanaka, MD, Nippon Medical School, Tokyo, Japan. "Until now, there has been no in-depth analysis about the diagnostic yield of DBE in patients with obscure GI bleeding. Our study showed that the sensitivity of DBE was 92.7 percent in the diagnosis of small intestinal lesions in patients with obscure GI bleeding and overall diagnostic yields were similar to those of capsule endoscopy."

Patients and Methods

This study examined 108 patients at the Nippon Medical School, Tokyo, Japan from July 2003 to February 2007 who had been referred for evaluation of obscure GI bleeding. Obscure GI bleeding was defined as overt GI bleeding or anemia in combination with stool test positive for blood of unknown cause despite negative upper and lower endoscopy. A stool blood test or fecal occult blood test (FOBT) is used to find small amounts of hidden (occult) blood in the stool. A sample of stool is tested for traces of blood.

The patients were classified into three groups before a DBE was performed: patients seen with active bleeding were classified as the overt-ongoing group (13 patients); patients with previous episodes though not active bleeding, were the overt-previous group (76 patients); and patients with positive fecal occult blood and a decrease in Hb level more than 2 g/dL comprised the occult group (19 patients). Researchers noted that during the study time frame, capsule endoscopy was introduced to the hospital. Therefore 36 of the 108 patients underwent both capsule endoscopy and DBE examinations, though DBE examination in this group, regardless of CE results, focused on the diagnostic precision of DBE for obscure GI bleeding.

Preparation for the DBE examination included a 12-hour overnight fast. Diagnostic biopsies or therapeutic procedures were performed during a DBE as necessary for any lesions discovered. Erosions or red spots that did not bleed during the examination were not considered the bleeding source. All patients were followed-up every two months until the end of the study for a period of at least nine months. The aims of the study investigators were to evaluate the diagnostic yield of DBE for obscure bleeding and assess the impact of DBE on the ultimate diagnosis and treatment plan.

Results

DBE demonstrated a diagnostic yield of 54.2 percent. However, DBE when examined in the context of symptomatic indication, gave a diagnosis for bleeding in 100 percent of patients with overt-ongoing bleeding, 48.4 percent of patients with overt-previous bleeding, and 42.1 percent of patients with occult bleeding. The difference in diagnostic yields between the overt-ongoing group and the two other groups was statistically significant (P

54.2 percent of patients had a potential source of small intestinal bleeding identified, while 45.8 percent of patients had a negative DBE. The most common sources of bleeding were ulcers (21/108 patients) and tumors (19/108). There were no serious complications encountered. Follow-up data was available for 93 patients. Eight patients (7.4 percent), four from the positive DBE and four from the negative DBE group, had recurrent bleeding during the mean follow-up period of 28.5 months. Sensitivity, specificity, positive, and negative predictive values of DBE in the diagnoses of small intestinal lesions in patients with obscure GI bleeding were 92.7 percent, 96.4 percent, 98.1 percent, and 87.1 percent, respectively.

The authors show that identification of a bleeding source in obscure GI bleeding is most likely when DBE is performed during or soon after a bleeding episode; similar conclusions have been reached on studies of CE. The authors propose that patients with obscure overt-ongoing bleeding ought to be examined by a DBE first for concurrent diagnosis and endoscopic hemostasis. In cases of overt-previous or occult obscure GI bleeding, the priority should be given to the less invasive CE. Future prospective studies should consider clinical outcomes such as cost-effectiveness, length of hospitalization, and the amount of blood transfusion, to clarify the role of CE and DBE in the diagnosis and management of obscure GI bleeding with overt-ongoing bleeding.

Anne Brownsey | EurekAlert!
Further information:
http://www.asge.org

More articles from Studies and Analyses:

nachricht The importance of biodiversity in forests could increase due to climate change
17.11.2017 | Deutsches Zentrum für integrative Biodiversitätsforschung (iDiv) Halle-Jena-Leipzig

nachricht Win-win strategies for climate and food security
02.10.2017 | International Institute for Applied Systems Analysis (IIASA)

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: A “cosmic snake” reveals the structure of remote galaxies

The formation of stars in distant galaxies is still largely unexplored. For the first time, astron-omers at the University of Geneva have now been able to closely observe a star system six billion light-years away. In doing so, they are confirming earlier simulations made by the University of Zurich. One special effect is made possible by the multiple reflections of images that run through the cosmos like a snake.

Today, astronomers have a pretty accurate idea of how stars were formed in the recent cosmic past. But do these laws also apply to older galaxies? For around a...

Im Focus: Visual intelligence is not the same as IQ

Just because someone is smart and well-motivated doesn't mean he or she can learn the visual skills needed to excel at tasks like matching fingerprints, interpreting medical X-rays, keeping track of aircraft on radar displays or forensic face matching.

That is the implication of a new study which shows for the first time that there is a broad range of differences in people's visual ability and that these...

Im Focus: Novel Nano-CT device creates high-resolution 3D-X-rays of tiny velvet worm legs

Computer Tomography (CT) is a standard procedure in hospitals, but so far, the technology has not been suitable for imaging extremely small objects. In PNAS, a team from the Technical University of Munich (TUM) describes a Nano-CT device that creates three-dimensional x-ray images at resolutions up to 100 nanometers. The first test application: Together with colleagues from the University of Kassel and Helmholtz-Zentrum Geesthacht the researchers analyzed the locomotory system of a velvet worm.

During a CT analysis, the object under investigation is x-rayed and a detector measures the respective amount of radiation absorbed from various angles....

Im Focus: Researchers Develop Data Bus for Quantum Computer

The quantum world is fragile; error correction codes are needed to protect the information stored in a quantum object from the deteriorating effects of noise. Quantum physicists in Innsbruck have developed a protocol to pass quantum information between differently encoded building blocks of a future quantum computer, such as processors and memories. Scientists may use this protocol in the future to build a data bus for quantum computers. The researchers have published their work in the journal Nature Communications.

Future quantum computers will be able to solve problems where conventional computers fail today. We are still far away from any large-scale implementation,...

Im Focus: Wrinkles give heat a jolt in pillared graphene

Rice University researchers test 3-D carbon nanostructures' thermal transport abilities

Pillared graphene would transfer heat better if the theoretical material had a few asymmetric junctions that caused wrinkles, according to Rice University...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Ecology Across Borders: International conference brings together 1,500 ecologists

15.11.2017 | Event News

Road into laboratory: Users discuss biaxial fatigue-testing for car and truck wheel

15.11.2017 | Event News

#Berlin5GWeek: The right network for Industry 4.0

30.10.2017 | Event News

 
Latest News

NASA detects solar flare pulses at Sun and Earth

17.11.2017 | Physics and Astronomy

NIST scientists discover how to switch liver cancer cell growth from 2-D to 3-D structures

17.11.2017 | Health and Medicine

The importance of biodiversity in forests could increase due to climate change

17.11.2017 | Studies and Analyses

VideoLinks
B2B-VideoLinks
More VideoLinks >>>