Push enteroscopy in the investigation of small-intestinal disease

We report our experience with small-bowel push enteroscopy in 50 patients.The indications for push enteroscopy were: anaemia/occult gastrointestinalbleeding (22 patients); overt gastrointestinal bleeding (17 patients);abnormal small-bowel radiology (8 patients) and miscellaneous (3 patients).In those with undiagnosed gastrointestinal bleeding/anaemia, abnormalitieswere detected in 24/39 patients (62%): small bowel arteriovenousmalformations (AVMs) were detected in 19 (49%), and five (13%) had lesionsin the upper gastrointestinal tract. Seventeen patients had heater-probeablation therapy of vascular lesions: nine patients had small-intestinallesions, four patients gastric lesions, and four patients combined gastricand small- intestinal lesions. In those with abnormal small-bowelradiology, abnormalities were detected in 6/8 patients. We conclude that(i) push enteroscopy can establish a diagnosis in a high proportion ofpatients with gastrointestinal bleeding; (ii) heater-probe ablation therapyof vascular lesions can be performed routinely at the time of enteroscopy;(iii) a significant proportion of patients (9/50) referred for enteroscopywith undiagnosed gastrointestinal bleeding have lesions in thestomach/proximal duodenum missed at diagnostic endoscopy. Push enteroscopyis a valuable diagnostic and therapeutic endoscopic procedure.