VIDEO PUSH ENTEROSCOPY IN THE INVESTIGATION OF SMALL-BOWEL DISEASE - DEFINING CLINICAL INDICATIONS AND OUTCOMES

Background: Push enteroscopy is a new technique for investigation of t he small intestine. The clinical indications are still being defined. It also offers the potential for therapeutic intervention in suitable cases. Aims: To evaluate further the role of push enteroscopy in the d iagnosis and treatment of patients with suspected or known small bowel disease. Methods: A prospective record was kept of all patients havin g enteroscopy at Royal Prince Alfred Hospital between March 1995 and J uly 1997. The procedure was performed 73 times in 68 patients. Indicat ions and diagnoses were noted. The outcome in patients with obscure ga strointestinal bleeding or anaemia in whom a vascular lesion was treat ed with a heater probe was also determined. Results: Enteroscopy was p erformed in 23 patients for gastrointestinal bleeding of obscure origi n. An active or possible bleeding source was found in 13 (57%). The co mmonest of these was jejunal angiodysplasia. In the 21 patients with c hronic iron deficiency anaemia a lesion was found in ten (48%). The ma jority of these were in the stomach, as described by others. The diagn ostic yield in the 16 patients having enteroscopy for known or suspect ed small bowel disease was 56%. One patient, underwent balloon dilatat ion of a postoperative jejunal stricture. Eleven patients with obscure bleeding or anaemia had ablation of a vascular lesion with a heater p robe. Transfusion requirements fell after this procedure, particularly in those with active bleeding at the time of the examination. In five of the 11 no further transfusions were required in over six months of follow-up. Conclusions: The most common indications for enteroscopy a re obscure gastrointestinal bleeding, chronic anaemia and known or sus pected small bowel disease. A positive result can be expected in over 50% of patients. The treatment of vascular lesions via the enteroscope has a significant impact of subsequent transfusion requirements.