B0456 - Early Intervention With Double Balloon Enteroscopy Has Higher Yield for Inpatient Overt Obscure Gastrointestinal Bleeding

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Mahmoud Aryan, MD

University of Alabama at Birmingham
Birmingham, AL

Mahmoud Aryan, MD¹, Tyler Colvin, MD¹, Lauren Daley, MD¹, Parth Patel, MD¹, Krishna Venkata, MD², Benjamin Nunley, MD¹, Nicholas Baldwin, MD¹, Ali M. Ahmed, MD¹, Kondal R. Kyanam Kabir Baig, MD¹, Shajan Peter, MD¹
¹University of Alabama at Birmingham, Birmingham, AL; ²University of Alabama at Birmingham, Montgomery, AL

Introduction: Obscure gastrointestinal bleeding (OOGIB) is defined as continued bleeding with unknown source despite esophagogastroduodenoscopy (EGD) and colonoscopy. Small bowel evaluation through video capsule endoscopy (VCE) or double balloon enteroscopy (DBE) is often warranted. We studied the timing of DBE in OOGIB regarding diagnostic yield, therapeutic yield, and GI re-bleeding.

Methods: We performed a retrospective review of DBEs performed at a tertiary medical center between 11/2012-12/2020. Inclusion criteria consisted of first admission for OOGIB undergoing DBE. Those without previous EGD or colonoscopy were excluded. Patients were stratified into 2 groups: DBE within 72 hours (hrs) of OOGIB (emergent) vs beyond 72 hrs of OOGIB (nonemergent). Logistic regression analysis assessed factors associated with diagnostic and therapeutic yield. Kaplan-Meir survival curve depicted GI bleed free survival following initial bleed and was compared using log rank test.

Results: A total of 154 patients met inclusion criteria of which 62 had emergent DBE and 92 had nonemergent DBE. Baseline variables were similar between our 2 groups. Univariate and multivariable logistic regression analysis depicted a significant associated between VCE and emergent DBE with diagnostic and therapeutic yields (P< 0.05). Emergent DBE patients had increased GI bleed free survival then the nonemergent group (log rank=0.001).

Discussion: Our data demonstrates emergent DBE during inpatient OOGIB can impact overall diagnostic yield, therapeutic yield, and GI rebleeding post-DBE.

Figure: Kaplan Meier Curve for GI bleed free survival up to 25 months following initial Double Balloon Enteroscopy

Diagnostic Yield
Variable	Univariate Analysis		Multivariable Analysis
	Odds Ratio [95% CI]	P value	Odds Ratio [95% CI]	P value
Age	1.02 [0.99-1.04]	0.16	1.01 [0.98-1.04]	0.51
Female	0.88 [0.46-1.71]	0.72	0.82 [0.39-1.71]	0.59
BMI< 25	1.66 [0.73-3.76]	0.22	1.61 [0.67-3.87]	0.29
ESRD	0.58 [0.23-1.47]	0.25	0.63 [0.21-1.85]	0.40
ICU admission	0.76 [0.37-1.56]	0.46	0.72 [0.33-1.58]	0.41
VCE	3.71 [1.83-7.52]	0.00	4.26 [1.98-9.20]	0.00
Emergent DBE	2.21 [1.10-4.46]	0.03	2.79 [1.28-6.08]	0.01
Therapeutic Yield
Variable	Univariate Analysis		Multivariable Analysis
	Odds Ratio [95% CI]	P value	Odds Ratio [95% CI]	P value
Age	0.96 [0.51-1.79]	0.89	1.00 [0.98-1.03]	0.87
Female	1.01 [0.99-1.04]	0.34	0.90 [0.45-1.81]	0.77
BMI< 25	1.21 [0.57-2.56]	0.62	1.13[0.51-2.53]	0.76
ESRD	0.41 [0.15-1.08]	0.07	0.42 [0.14-1.24]	0.12
ICU admission	1.02 [0.51-2.05]	0.96	0.99 [0.46-2.11]	0.98
VCE	2.77 [1.38-5.56]	0.00	3.26 [1.53-6.94]	0.00
Emergent DBE	2.36 [1.22-4.59]	0.01	2.79 [1.36-5.70]	0.00

Disclosures:

Mahmoud Aryan indicated no relevant financial relationships.

Tyler Colvin indicated no relevant financial relationships.

Lauren Daley indicated no relevant financial relationships.

Parth Patel indicated no relevant financial relationships.

Krishna Venkata indicated no relevant financial relationships.

Benjamin Nunley indicated no relevant financial relationships.

Nicholas Baldwin indicated no relevant financial relationships.

Ali Ahmed indicated no relevant financial relationships.

Kondal Kyanam Kabir Baig: Ambu – Consultant. Ambu – Grant/Research Support. Olympus – Grant/Research Support.

Shajan Peter indicated no relevant financial relationships.

Mahmoud Aryan, MD¹, Tyler Colvin, MD¹, Lauren Daley, MD¹, Parth Patel, MD¹, Krishna Venkata, MD², Benjamin Nunley, MD¹, Nicholas Baldwin, MD¹, Ali M. Ahmed, MD¹, Kondal R. Kyanam Kabir Baig, MD¹, Shajan Peter, MD¹. B0456 - Early Intervention With Double Balloon Enteroscopy Has Higher Yield for Inpatient Overt Obscure Gastrointestinal Bleeding, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.