Introduction Device assisted enteroscopy (DAE) has developed rapidly over the past decade, particularly with the advent of double balloon enteroscopy (DBE). The present study reports a case series from a tertiary centre for enteroscopy in the Southwest of the UK serving approximately 1 million people. Data was collected across three modalities of enteroscopy - DBE, Spiral enteroscopy (SE) and push enteroscopy (PE) - under conscious sedation.
Methods Observational study of 343 enteroscopy procedures in 271 patients referred for enteroscopy from 2008 to 2014. Data were collected on patient demographics, procedure indications, diagnosis, sedation requirements, extent, duration, complications, tolerance and types of therapy performed. Completion rate was defined as a DAE procedure that changed patient management via therapy, diagnosis or normal finding. All patients who had procedures during the study period were included in the analysis. Ethical review was obtained from North Bristol NHS Trust local ethics committee. Comparison of numerical data was performed using t-test or one-way ANOVA analysis for comparison of multiple means. Comparison of categorical data was performed using chi-squared testing or correlation testing.
Results Obscure GI bleeding (OGIB) was the commonest indication for DAE (n = 205, 59.7%). The overall yield of DAE was low (48.5%), with greater likelihood of positive findings if the indication was OGIB (55% vs 37.6%, p < 0.001) and in older patients (mean age normal exam 60.0 vs. abnormal exam 66.5 years, p < 0.001). Higher mean doses of midazolam were used for DBE from above (DBEa) (5.4 mg) and SE (5.6 mg) with lower doses for DBE from below (DBEb) (4.4 mg) and PE (3.8 mg). No serious complications were reported over the study period. SE was associated with shorter procedure time and shorter depth of insertion when compared to DBEa. Tolerance of DAE under conscious sedation was good with the majority (313/343, 91.2%) of procedures tolerated with comfort score 0 or 1 (out of 3). PE was significantly better tolerated whilst DBEb and SE were significantly worse tolerated than DBEa (p < 0.001). Therapy was performed in 154/343 (44.9%) of procedures. Indications of OGIB (p = 0.021) and prior abnormal capsule endoscopy (p = 0.026) predicted performing therapy at DAE. Completion rates were more likely with DBEb (92.2% vs 69.9%, p < 0.001) and less likely with PE (63% vs 77.8%, p = 0.006).
Conclusion Small bowel enteroscopy under conscious sedation is safe and generally well tolerated. The procedure is of low yield; however this is a complex and extensively investigated cohort of patients. Nonetheless, small bowel enteroscopy should be used primarily for therapy once a diagnosis has been made by other modalities such as wireless capsule endoscopy.
Disclosure of Interest None Declared
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