Diagnostic value of push-type enteroscopy: A report from India

OBJECTIVE: We sought to assess the diagnostic value of push-type enteroscop y in relation to indications. METHODS: Ninety-nine consecutive patients (mean age, 42 +/- 15 yr; 65 men) with suspected small bowel disorders underwent push enteroscopy. The indica tions were chronic diarrhea (n = 54), obscure gastrointestinal (GI) bleedin g (n = 21), abdominal pain (n = 10), abnormal radiological studies of small bowel (n = 5), iron deficiency anemia (n = 5), and others (n = 4). Push en teroscopy was performed using the Olympus SIF-10 (160-cm) enteroscope. RESULTS: Endoscopic examination of the jejunum was successful in all the pa tients, except one with a distal duodenal structure. The length of the jeju num examined ranged from 10 to 70 cm. The time taken to complete the proced ure varied from 2 to 30 min. Lesions were found in nine (42.8%) patients wi th obscure GI bleeding; six (28.5%) had worms (Ascaris lumbricoides [n = 3] , Ankylostoma duodenale [n = 3]) in the jejunum, producing multiple erosion s and bleeding points. In the chronic diarrhea group, a diagnosis was made in 13 (24%) patients on enteroscopic visualization and jejunal histology: c eliac disease (n = 6), tropical sprue (n 3, Crohn's disease (n = 1), second ary lymphangiectasia (n = 1), strongyloidiasis (n = 1), and nodular lymphoi d hyperplasia with giardiasis (n = 1). In patients with abdominal pain, ent eroscopy provided a diagnosis in one (10%) patient. No positive diagnosis c ould be made on enteroscopy in patients with iron deficiency anemia and abn ormal radiological studies of small bowel. CONCLUSION: Push-type enteroscopy is a useful test in the evaluation of pat ients with obscure GI bleeding and chronic diarrhea. In developing countrie s, in patients with obscure GI bleeding, the presence of worms in the jejun um is an important finding on enteroscopy. Tropical sprue, giardiasis, and strongyloidiasis are distinct findings in patients with chronic diarrhea in the present series.