Su1297 LONG-TERM OUTCOMES AFTER DOUBLE-BALLOON ENTEROSCOPY IN PATIENTS SUSPECTED OF OVERT SMALL BOWEL BLEEDING

Rintaro Hashimoto; Tomoki Matsuda

doi:10.1016/j.gie.2018.04.1684

Background and Aims Double-balloon enteroscopy (DBE) is a safe and useful procedure for managing the small bowel disease. However, there are few data concerning the long-term outcomes of patients with overt small bowel bleeding and the effect of DBE on it. The aim of this study was to evaluate the long-term outcomes of patients suspected of small bowel bleeding who underwent DBE. Methods We reviewed the medical records of the patients undergoing DBE procedures, and letter/telephone interviews were conducted in April 2017. 297 patients suspected of overt small bowel bleeding had DBE between April 2004 and March 2016. We classified the patients into overt small bowel bleeding group and overt obscure gastrointestinal bleeding (OGIB) group according to ACG guideline published in 2015. Results A cohort of 187 patients could be followed. On the first bleeding episode, 94 patients had positive findings in the small bowel (small bowel bleeding group). 63 patients had negative results (OGIB group). 30 patients were eventually judged as gastrointestinal bleeding other than small bowel. In small bowel bleeding group, nine patients received surgery for Meckel diverticula (n=5) and tumor (n=4). In the remaining patients, 48/85 patients (56.4%) had recurrent bleeding with 2675 days follow up. Three patients (3.2%) died within a month after DBE. The rebleeding occurred often both in ulcerative lesions (32/46, 69.6%) and vascular lesions (14/24, 58.3%). In OGIB group, 21/63 patients (33.3%) had recurrent bleeding with 2490 days follow up, and all of them underwent DBE again within 24 hours after the last bleeding episode. The source of bleeding was identified in 19/21 patients (90.5%) and most of them (15/19, 78.9%) had lesions in the small bowel. Blood transfusion at the first bleeding episode was associated with rebleeding (rebleeding 85.7% vs. non-rebleeding 35.1%, p=0.0004). One patient (1.6%) died within a month after DBE due to uncontrollable duodenal bleeding. The rebleeding rate was higher in small bowel bleeding than OGIB (56.4% vs.33.3%, p=0.008). There is no significant difference between two groups in the background, including mean period to rebleeding (534.2 days vs. 684.3 days, p=0.45). However, the most common source was small bowel vascular lesion (12/19, 63.2%) in OGIB, while the most common source was ulcerative lesion (32/48, 66.7%) in small bowel bleeding. Conclusion The rebleeding rate in overt small bowel bleeding was relatively high regardless of the bleeding source, even after the first DBE was therapeutic, as in previous studies. In overt OGIB, the rebleeding rate was lower than in small bowel bleeding but still not negligible. In this group, urgent DBE was effective to define the bleeding source on rebleeding. This result shows that careful observation and urgent DBE on rebleeding may be important even in OGIB, same as in small bowel bleeding.

Su1297 LONG-TERM OUTCOMES AFTER DOUBLE-BALLOON ENTEROSCOPY IN PATIENTS SUSPECTED OF OVERT SMALL BOWEL BLEEDING

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