Is push enteroscopy useful in patients with malabsorption of unclear origin?

OBJECTIVE: The aim of this study was to determine the diagnostic value of p ush enteroscopy in patients with chronic diarrhea and malabsorption of uncl ear origin. METHODS: From January, 1997, to September, 1999, 16 consecutive patients wi th chronic diarrhea and biological signs of intestinal malabsorption but no evidence of celiac disease were explored by push enteroscopy. Previous duo denal histological findings had been normal in seven patients and abnormal but inconclusive in nine patients. Endoscopic and histological findings in the duodenum and in the jejunum were compared. RESULTS: Push enteroscopy with jejunal biopsy yielded a diagnosis in compar ison with duodenal biopsy in two of 16 (12%) patients, respectively, in two of the nine (22%) patients with abnormal but inconclusive findings on duod enal biopsy, and none of the seven patients with normal duodenal histology. In the two patients in whom jejunal biopsy had diagnostic value but duoden al biopsy did not, the final diagnoses were invasive intestinal lymphoma an d microsporidiosis. CONCLUSION: Push enteroscopy had diagnostic value in only 12% of patients w ith malabsorption of unclear origin, all of whom had had abnormal but incon clusive duodenal histological findings. Push enteroscopy with jejunal biops y appears to have limited diagnostic value in patients with chronic diarrhe a and malabsorption, especially when duodenal biopsies are histologically n ormal.