PUSH ENTEROSCOPY AND HEATER PROBE THERAPY FOR SMALL-BOWEL BLEEDING

Background: Blood loss from the small bowel is a significant cause of obscure gastrointestinal bleeding. Small bowel angiodysplasia may be t he source of bleeding in 30% to 40% of patients with this problem. In other areas of the bowel, angiodysplasia has been effectively treated by endoscopic methods. Methods: We used a 1.7 meter push enteroscope a nd heater probe ablation to examine and treat 11 transfusion-dependent patients with significant bleeding from small bowel angiodysplasia. P atients had push enteroscopy to target all lesions identified and had follow-up hemoglobin and fecal occult blood tests for a minimum of 6 m onths after final enteroscopy. Results: There were a median of 2 (rang e 1 to 7) small bowel lesions per patient. Patients required a median of 1 (range 1 to 5) examination to treat lesions identified at enteros copy. Following therapy, hemoglobin levels rose significantly from a m edian of 8.5 (range 5.3 to 10.6) gm/dl) to a median of 13.5 (range 7.6 to 16.5) gm/dL (p < 0.01 Wilcoxon matched pair signed rank test). Con clusion: Push enteroscopy and heater probe ablation offer potential th erapy for bleeding from small bowel angiodysplasia and result in reduc tion of blood loss and transfusion requirements along with a significa nt improvement in levels of hemoglobin.