Clinical Features And Outcomes Of Patients Suspected With Small Intestinal Bleeding Undergoing Double-balloon Endoscopy

ObjectiveDouble-balloon endoscopy(DBE)is an effective method for the diagnosis and treatment of small intestinal diseases.This study aims to explore the diagnostic yield of double-balloon endoscopy for small intestinal diseases between patients of different ages and clinical features and outcomes of patients suspected with small intestinal bleeding undergoing DBE.Methods.1.A retrospective study was performed by collecting clinical data of patients who were submitted to DBE procedures at our center from May 2009 to August 2020.The patients were divided into two groups according to the age: the youth group(patients≤40 years of age)and the elderly group(patients>40 years of age).The endoscopic findings and complications were compared between two groups.2.A retrospective study was performed by collecting clinical data of patients who were suspected with small intestinal bleeding undergoing DBE from March 2012 to August 2020.The included patients were divided into DBEpositive and DBE-negative groups,and the difference between two groups patients were compared.Independent risk factors for re-bleeding and death were identified by logistic regression univariate and multivariate analysis.Results1.In our study,a total of 707 patients completed 851 DBE.The 707 patients were divided into two age groups,276 patients in the youth group and431 patients in the elderly group.The overall detection rate of DBE in this study was 67.21%(572/851).The most common lesion found in both groups of patients were erosions and ulcers,with no statistical difference between the two groups of patients(25.4% vs 19.4%,P>0.05).The youth group had a higher detection rate of small intestinal polyps than the elderly group(12.3% vs 3.5%,P < 0.0001).The detection rate of inflammatory bowel disease(IBD)in the youth group was also higher than that in the elderly group(7.6% vs 3.5%,P=0.014).However,the detection rate of tumors and other space-occupying lesions was lower in the youth group than in the elderly group(5.8% vs 12%,P=0.006).Postoperative complications occurred in 2 patients in both groups(0.7% vs 0.5%,P=0.652).2.A total of 168 patients were included in this study.128 patients were diagnosed with small intestinal lesions in DBE positive group.40 patients were not diagnosed with small intestinal lesions in DBE negative group.Major endoscopic findings were erosions/ulcerations.DBE positive group had significantly shorter interval between last bleeding and DBE(7 days versus 10 days,p=0.041),lower rate of hematemesis(1.56% versus 12.5%,p=0.003),longer APTT(35.90 s versus 33.10 s,p=0.022),higher proportion of surgery after DBE(27.3% versus 5.0%,p=0.003),and higher incidence of re-bleeding after DBE during hospitalization(19.5% versus 5.0%,p=0.029),and more cost of hospitalizations than DBE negative group(23465.47 versus 17902.36,p=0.009).Shorter interval between last bleeding and DBE(OR=0.919,95% CI0.848-0.997,p=0.041)and diverticulum(OR=3.190,95% CI 1.037-9.814,p=0.043)were independently associated with an increased risk of re-bleeding after DBE during hospitalization.Crohn’ s disease was independently associated with an increased risk of re-bleeding during follow-up(OR=4.408,95%CI=1.207-16.099,p=0.025).Multivariate logistic regression analysis demonstrated that adenocarcinoma(OR=27.864,95%CI=2.255-344.267,p=0.009)was independently associated with an increased risk of death during follow-up.Conclusion1.DBE has a relatively high diagnostic rate of small intestinal diseases,and the spectrum of disease among patients is different between the youth and the elderly groups.DBE has few postoperative complications and is a relatively safe procedure.2.Urgent DBE examination is easier to find lesions,and the most common classification of lesions is erosions/ulceration.Multivariate logistic regression analysis demonstrated that shorter interval between last bleeding and DBE and diverticulum were independently associated with an increased risk of rebleeding after DBE during hospitalization;crohn disease was independently associated with an increased risk of re-bleeding during follow-up;adenocarcinoma was independently associated with an increased risk of death during follow-up.