Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan.
Division of Gastroenterology, University of California Irvine, 101 The City Drive, Bldg. 22C, Orange, CA, 92868, USA.
Surg Endosc. 2019 Aug;33(8):2635-2641. doi: 10.1007/s00464-018-6561-x. Epub 2018 Nov 5.
Double-balloon enteroscopy (DBE) performed to investigate overt small bowel bleeding can miss the source of bleeding. We investigated the clinical outcomes of patients with negative DBE results for suspected overt small bowel bleeding, which is defined in the current guidelines as obscure gastrointestinal bleeding.
We reviewed the prospectively collected medical records of patients who underwent DBE at our hospital between May 1, 2004 and April 30, 2016. During this period, 297 patients underwent DBE for suspected overt small bowel bleeding. The first DBE yielded negative results for 83 patients (27.9%). Written interviews, telephone interviews, and medical records of these patients were reviewed in April 2017. Follow-up data were collected for 63 patients (75.9%).
During a mean follow-up period of 83.5 months, re-bleeding occurred in 21 of 63 patients (33.3%) after a mean of 23.0 months after the first DBE yielded negative results. The bleeding source was identified in 19 of 21 patients (90.5%). In 15 of these 19 patients (78.9%), the source was the small intestine. Among these 15 patients, 14 (93.3%) had bleeding sites within reach of the first DBE and 3 (20%) experienced their first incidence of re-bleeding more than 3 years after the first DBE. The need for transfusion for the first bleeding episode was a predictor of re-bleeding (odds ratio 7.5; 95% confidence interval 1.7-33.0).
False-negative DBE results for overt small bowel bleeding are not rare, and the first re-bleeding episode can occur 3 years later. Repeat DBE when re-bleeding occurs should be considered, even if the first DBE results were negative.
为了检查显性小肠出血而进行的双气囊内镜（DBE）可能会遗漏出血源。我们研究了在当前指南中定义为隐性胃肠道出血的疑似显性小肠出血患者的阴性 DBE 结果的临床结果。
我们回顾了 2004 年 5 月 1 日至 2016 年 4 月 30 日期间在我院接受 DBE 的患者的前瞻性收集的病历。在此期间，有 297 例患者因疑似显性小肠出血而行 DBE。83 例患者（27.9%）的首次 DBE 结果为阴性。2017 年 4 月对这些患者进行了书面访谈、电话访谈和病历回顾。对 63 例患者（75.9%）进行了随访数据收集。
在平均 83.5 个月的随访期间，首次 DBE 结果为阴性后平均 23.0 个月，有 21 例（33.3%）患者再次出现出血。在 21 例患者中有 19 例（90.5%）确定了出血源。在这 19 例患者中有 15 例（78.9%）为小肠来源。在这 15 例患者中，有 14 例（93.3%）的出血部位可触及首次 DBE，有 3 例（20%）在首次 DBE 后 3 年以上首次发生再出血。首次出血时需要输血是再出血的预测因素（比值比 7.5；95%置信区间 1.7-33.0）。
显性小肠出血的假阴性 DBE 结果并不罕见，首次再出血可发生在 3 年后。发生再出血时应考虑重复 DBE，即使首次 DBE 结果为阴性。
