PUSH ENTEROSCOPY IN THE INVESTIGATION OF SMALL-INTESTINAL DISEASE

We report our experience with small-bowel push enteroscopy in 50 patie nts. The indications for push enteroscopy were: anaemia/occult gastroi ntestinal bleeding (22 patients); overt gastrointestinal bleeding (17 patients); abnormal small-bowel radiology (8 patients) and miscellaneo us (3 patients). In those with undiagnosed gastrointestinal bleeding/a naemia, abnormalities were detected in 24/39 patients (62%): small bow el arteriovenous malformations (AVMs) were detected in 19 (49%), and f ive (13%) had lesions in the upper gastrointestinal tract. Seventeen p atients had heater-probe ablation therapy of vascular lesions: nine pa tients had small-intestinal lesions, four patients gastric lesions, an d four patients combined gastric and small-intestinal lesions. In thos e with abnormal small-bowel radiology, abnormalities were detected in 6/8 patients. We conclude that (i) push enteroscopy can establish a di agnosis in a high proportion of patients with gastrointestinal bleedin g; (ii) heater-probe ablation therapy of vascular lesions can be perfo rmed routinely at the time of enteroscopy; (iii) a significant proport ion of patients (9/50) referred for enteroscopy with undiagnosed gastr ointestinal bleeding have lesions in the stomach/proximal duodenum mis sed at diagnostic endoscopy. Push enteroscopy is a valuable diagnostic and therapeutic endoscopic procedure.