Long-term outcome of patients treated with double balloon enteroscopy for small bowel vascular lesions

Am J Gastroenterol. 2012 Feb;107(2):240-6. doi: 10.1038/ajg.2011.325. Epub 2011 Sep 27.


Objectives: Early rebleeding rate after endoscopic therapy with double balloon enteroscopy (DBE) of hemorrhagic small bowel vascular lesions (SBVL) varies between 10 and 50%. In recent reports, long-term follow-up of patients have been described but rebleeding risk factors are still not well established. The aim of the current study was to identify long-term treatment success rate and rebleeding risk factors after DBE therapy in a large cohort.

Methods: We conducted a single-center, retrospective cohort study in a large French tertiary-referral center between January 2004 and December 2007.

Results: Among 261 patients presenting with obscure gastrointestinal bleeding (OGIB), SBVL was present in 133 patients and was treated successfully in 129 (97%) using mainly argon plasma coagulation. Ninety-eight patients were followed up for a mean period of 22.6±13.9 months (range 1-52). Rebleeding rate was 46% (45/98 patients) at 36 months. On multivariate analysis, the total number of observed lesions (hazard ratio (HR): 1.15, 95% confidence interval (CI): 1.06-1.25, P=0.001) and the presence of a valvular and/or arrhythmic cardiac disease (HR: 2.50, 95% CI: 1.29-4.87, P=0.007) were significantly associated with the risk of rebleeding. Complication rate of therapeutic DBE was 2.3% with no mortality.

Conclusions: Endoscopic therapy using DBE for SBVL in patients with recurrent OGIB allows a long-term remission in more than half of the patients. Independent rebleeding risk factors after a first endoscopic therapy are an increased number of SBVL and an associated valvular/arrhythmic heart disease.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Double-Balloon Enteroscopy*
  • Female
  • Follow-Up Studies
  • Gastrointestinal Hemorrhage / surgery*
  • Humans
  • Intestinal Diseases / surgery*
  • Intestine, Small / surgery*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome