The importance of indication in the diagnostic value of push enteroscopy.

BACKGROUND AND STUDY AIMS: Small-bowel enteroscopy (SBE) is frequently used to examine patients suspected of small-bowel disease. Unfortunately, the diagnostic yield varies widely, from 13 % to 78 % of cases. This disparity may be in part attributable to the vast array of indications for the use of the procedure. The purpose of this study was to examine the diagnostic yield of small-bowel enteroscopy for various indications. PATIENTS AND METHODS: This is a retrospective cohort study of all patients who underwent SBE over a 5-year period, from 1995 to 1999. RESULTS: The indications were grouped into in-patient gastrointestinal blood loss (46% of the patient population), outpatient gastrointestinal blood loss (33 %), abnormal radiographic study (7%), iron-deficiency anemia (5%), and others (9%, defined as anemia not otherwise specified, abdominal pain, nausea and vomiting, diarrhea, and weight loss). The overall diagnostic yield was 42 %. Gastrointestinal bleeding had the highest yield, at 44% (in-patient gastrointestinal blood loss 51%, outpatient gastrointestinal blood loss 40%; P=0.1314). Patients with iron-deficiency anemia had a yield of 42%, and patients with a previous abnormal radiograph had a yield of 41%. The combined diagnostic yield for the indications in the "other" category was 21% --significantly lower than in patients with gastrointestinal bleeding, abnormal radiographs, and iron deficiency (P=0.049). CONCLUSIONS: SBE is safe and useful in the evaluation of small-bowel disease. Although the overall yield is highly dependent on the specific indication, it is effective for patients with in-patient or outpatient gastrointestinal blood loss, patients with abnormal radiographs that demonstrate small-bowel pathology considered to be within reach of the enteroscope, and iron-deficiency anemia. There are insufficient data to support the use of enteroscopy for other indications such as anemia not otherwise specified, abdominal pain, nausea and vomiting, and chronic diarrhea, and in these cases it is unlikely to be useful.

Duke Scholars

Author Malcolm Stanley Branch Medicine, Gastroenterology