2 WAY PUSH VIDEOENTEROSCOPY IN INVESTIGATION OF SMALL-BOWEL DISEASE

Aims-To evaluate the diagnostic yield and safety of a new push type vi deoenteroscope (PVE) for diagnosis of small bowel disease. Methods-Thr ee hundred and thirteen patients were referred for one or two way PVE from December 1993 to June 1996. Indications for PVE were: an unexplai ned iron deficiency anaemia with or without clinically evident gastroi ntestinal bleeding; or a complementary investigation for suspected sma ll bowel disease, after a small bowel barium follow through (SBBFT) co nsidered as normal or abnormal, but without a definite diagnosis. Resu lts-A jejunoscopy and a retrograde ileoscopy were carried our in 306 a nd 234 patients, respectively. In patients with isolated anaemia (n=13 1) and those with clinically evident gastrointestinal bleeding associa ted anaemia (n=72), PVE provided a diagnosis in 26 (19.8%) and 22 (30. 5%) cases, respectively. Lesions found were located in the jejunoileum in 30 (14.7%) patients and in the gastroduodenum or the colon in 18 ( 8.8%) patients-that is, within the reach oft he conventional gastrosco pe/ colonoscope. In patients with normal (n=54) or abnormal (n=56) SBB FT, PVE provided a diagnosis in 17 (31%) and 27 (48%) cases, respectiv ely. In 25% of cases, the abnormal appearance of SBBFT was not confirm ed. The site of the radiological abnormality was not reached in 27% of cases. Lesions were located at the jejunum and the ileum in 59 (64%) and 33 (36%) cases, respectively. Conclusions-PVE is useful in around 30% of cases of unexplained anaemia or after an SBBFT which failed to provide an accurate aetiological diagnosis. Use of retrograde videoent eroscopy increases diagnostic yield by one third.