Combined Use of Capsule Endoscopy and Double-balloon Enteroscopy in Patients with Obscure Gastrointestinal Bleeding

Background: Most of the sources of bleeding in patients with obscure gastrointestinalbleeding are located in the small bowel. Capsule endoscopy (CE) and double-balloon enteroscopy (DBE) are innovative modalities to examine thesmall intestine. This study evaluated the combined use of CE and DBE inpatients with obscure gastrointestinal bleeding.Methods: From October 2005 to November 2006, ten patients with obscure gastrointestinalbleeding who underwent CE followed by DBE were included in thisstudy. The insertion route for DBE was determined according to the site ofobscure gastrointestinal bleeding detected by CE in nine patients. Theanterograde route was selected when the estimated location of the lesion wasin the proximal two- thirds of the small bowel and the retrograde route waschosen when the estimated location was after the proximal two-thirds. In onepatient without a definite lesion detected by CE, the route of insertion wasdetermined according to clinical judgment.Results: Eleven capsule endoscopies were performed in ten patients. Significant orsuspicious small bowel lesions were discovered by CE in nine (90%; 9/10)patients, including angiodysplasia (n = 3), active bleeding (n = 3), a polypoidlesion (n = 1), suspected enteritis (n = 1) and gastric antral vascular ectasiawith small bowel bleeding (n = 1). Eleven DBE were performed in tenpatients. Significant small bowel lesions were detected by DBE in eightpatients (80%), including angiodysplasias (n = 3), lymphangioectasias (n =2), varices (n = 1), polypoid lesion (n = 1) and Dieulafoy’s lesion (n = 1).Endoscopic treatments were performed successfully in 7 patients, includingargon plasma coagulation in four, heat probe coagulation in one, endoscopicmucosal resection in one and sclerotherapy in one.Conclusions: CE can provide useful information on the indications for DBE and the selectionof the route of DBE. DBE can verify the findings of CE and providetherapeutic intervention. Combined use of CE and DBE is effective in thediagnosis and management of patients with obscure gastrointestinal bleeding.