Use of the enteroscope for colo-ileoscopy: Low yield in unexplained lower gastrointestinal bleeding

Background and Study Aims: The small intestine is a potential origin of ble eding in patients with unexplained gastrointestinal tract hemorrhage or iro n-deficiency anemia. Most reports on the investigation of these patients de scribe the use of upper tract enteroscopy. The diagnostic yield of combined upper and loner enteroscopy has not been widely assessed and remains to be clarified. The aim of this study was to assess the benefit of lower gastro intestinal tract enteroscopy in occult digestive bleeding. Patients and Methods: Between 1 December 1995 and 15 January 1998, 54 patie nts with gastrointestinal bleeding of unknown origin were prospectively stu died using upper and loner video push enteroscopy (44 for chronic iron-defi ciency anemia and 10 for unexplained gastrointestinal tract hemorrhage with no potential site having been identified by other investigations). Examina tions were done using a Olympus video enteroscope (SIF-100) under general a nesthesia in a one-day clinic. An upper tract examination was done first, d irectly followed by the lower tract investigation. Results: The upper tract enteroscopy was successful in 53 patients (98%) an d retrograde ileoscopy in 21 patients (39%). In 18 (38%) cases the technica l failure resulted from the impossibility of intubating the ileocecal valve . A potential source of upper gastrointestinal bleeding was detected in 35% of patients with chronic iron-deficiency anemia and in 20% of those with u nexplained gastrointestinal tract hemorrhage. The most common lesion in the small bowel was angiodysplasia (25%), The lower tract video push enterosco py disclosed 11 lesions in patients with chronic anemia. However the lesion s, including two ileocecal valve cancers, were mainly located in the colon and had been missed by previous colonoscopy. No case of ileal lesion was de tected in this group of patients. In patients with unexplained gastrointest inal tract hemorrhage, three lesions were detected but only one of these wa s In the ileum. Associated colonic and jejunal lesions were observed in thr ee patients (5.5%). Overall, the diagnostic yield of lower video push enter oscopy was less than 2%. Conclusion: This prospective study has shown that using an enteroscope as a colonoscope In the management of patients with gastrointestinal bleeding o f unknown origin is of little help, It might actually be more appropriate t o perform a second colonoscopy. This however remains controversial and a pr ospective study is needed to answer that question.