THE VALUE OF PUSH ENTEROSCOPY OF THE SMAL L-BOWEL - A PROSPECTIVE-STUDY

Objective: To evaluate whether push enteroscopy of the small bowel (PE S), undertaken after extensive previous investigations in suspected in testinal bleeding from an uncertain site, chronic diarrhoea or lymphom a of the small intestine, contributes to the diagnosis, and to ascerta in the results of PES and its clinical significance. Patients and meth ods: 56 consecutive patients (29 men, 27 women; mean age 63 years) wer e investigated prospectively. The main indications for PES were the se arch for the source of intestinal bleeding in 79% of patients (group A ), chronic diarrhoea or tropical sprue in 16% (group B) and search for tumour of lymphoma in 5% (group C). PES was always performed in fasti ng patients under sedation/analgesia using a video PES, which contrary to catheter enteroscopy provides a channel for intervention. Results: In group A 27% of patients were found to have lesions, in particular angiodysplasias, or (in once case) leiomyoma. Half of these patients w ere successfully treated endoscopically without later surgical interve ntion being required (mean follow-up of six months). In the other half operation became necessary, either because the disease itself indicat ed it or the bleeding persisted, the source being in the more distant small intestine and thus not accessible to endoscopic intervention: on ly 50% of the length of the small intestine proved to be within reach of the instrument. No abnormalities were discovered in patients of gro ups B and C. Conclusion: In cases of gastrointestinal bleeding from an uncertain source PES should be performed first, because in many cases it may obviate surgical intervention. But PES seems to contribute lit tle of diagnostic value in other indications.