DIAGNOSTIC AND THERAPEUTIC IMPACT OF PUSH ENTEROSCOPY - ANALYSIS OF FACTORS ASSOCIATED WITH POSITIVE FINDINGS

Background: Push enteroscopy is indicated in patients with suspected s mall bowel gastrointestinal bleeding or small bowel mucosal disease. O ur aim was to determine the diagnostic yield of enteroscopy, identify clinical predictors associated with findings, and measure frequency of management changes made on the basis of results. Methods: Endoscopy r eports, office charts, and hospital charts were reviewed for 164 patie nts who had enteroscopy performed, primarily with a video enteroscope, during a period of 2 years. Data extraction included details of comor bid illnesses, associated risk factors, and previous endoscopies. Resu lts: Indications for enteroscopy were suspected occult bleeding in 65, overt bleeding in 64, diarrhea in 20, and suspected mucosal disease i n 15 patients. Diagnostic lesions, identified in 92 patients (56%), in cluded 57 jejunal lesions (35%). In patients with overt bleeding, uppe r tract lesions were present more commonly in patients receiving nonst eroidal medication (54% versus 27%, p < 0.05). Jejunal vascular ectasi a occurred more frequently in patients with documented vascular ectasi as elsewhere in the gastrointestinal tract (34% versus 15%, p < 0.01). Missed lesions on previous upper endoscopy included large hiatal hern ias with erosions in 10, peptic ulcers in 10, and vascular ectasias in 9 patients. Therapeutic interventions, made in 67 of 92 patients (73% ) with diagnostic lesions, included small bowel resection in 12 (8%), endoscopic therapy in 21 (14%), and changes in medical regimen in 34 p atients (22%). Conclusions: Push enteroscopy with video enteroscopes h as a moderate diagnostic yield. Positive findings frequently lead to t herapy changes. Large hiatal hernias remain an under-recognized etiolo gy of anemia. Repeat upper endoscopy should be considered before enter oscopy in patients taking non-steroidals who develop overt bleeding.