Double-balloon enteroscopy in the elderly with obscure gastrointestinal bleeding: safety and feasibility

Eur J Gastroenterol Hepatol. 2013 Oct;25(10):1230-4. doi: 10.1097/MEG.0b013e3283630f1b.


Background: Double-balloon enteroscopy (DBE) is a novel endoscopic procedure to access the small bowel. There is paucity of data on its use in the elderly.

Objective: The aim of this study was to assess the utility of DBE in patients with obscure gastrointestinal bleeding (OGB) in terms of safety and feasibility.

Materials and methods: A prospective review of consecutive patients who underwent DBE for OGB was conducted. Data were collected on demographics, dose of sedation/analgesia, diagnostic yield, and management and complications. Patients were divided into group 1, age of at least 70 years, and group 2, age less than 70 years.

Results: A total of 148 DBE procedures were carried out for OGB. Group 1 (age≥70 years) comprised 27% (n=40) of the cohort with a mean age of 77 years (range 70-83 years). The mean age in group 2 (n=108) was 54 years, 44% women. The diagnostic yield in group 1 was 53 versus 35% in group 2 (P=0.06). Subsequent management was altered more frequently in group 1 (50 vs. 28%, P=0.01, odds ratio 2.6, 95% confidence interval 1.2-5.5). Sedation requirement was less in the elderly (median dose of midazolam, group 1: 4.5 mg versus group 2: 6 mg, P<0.001; fentanyl, group 1: 50 mcg vs. group 2: 75 mcg, P<0.001). There was no significant difference in complications between the two groups (0/40 vs. 1/108, P=0.54). On logistic regression, increasing age (P=0.008) was associated with a higher yield with DBE in all patients.

Conclusion: DBE is safe, has a high diagnostic yield and has a positive impact on patient management in the elderly.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anemia, Iron-Deficiency / etiology
  • Angiodysplasia / complications
  • Angiodysplasia / diagnosis
  • Comorbidity
  • Conscious Sedation / methods
  • Double-Balloon Enteroscopy / adverse effects*
  • Double-Balloon Enteroscopy / methods
  • Feasibility Studies
  • Female
  • Gastrointestinal Hemorrhage / etiology*
  • Humans
  • Intestinal Neoplasms / complications
  • Intestinal Neoplasms / diagnosis
  • Intestine, Small
  • Male
  • Middle Aged
  • Prospective Studies
  • Recurrence
  • Young Adult