Clinical features predicting the detection of abnormalities by double balloon endoscopy in patients with suspected small bowel bleeding

Background and Aim:  Although double balloon endoscopy (DBE) has demonstrated a high diagnostic yield in suspected small bowel bleeding, it is not known whether DBE is of equal value to all patients with suspected small bowel bleeding or of greater benefit in selected subgroups. We aimed to determine whether any clinical features predict an increased likelihood of finding a lesion in patients with suspected small bowel bleeding.
Methods:  We retrospectively analyzed clinical features of 43 consecutive patients (M : F = 26:17, age 13–82 years) who underwent DBE because of suspected small bowel bleeding. Data associated with DBE procedure were collected prospectively. Predictive factors for the detection of a lesion were determined by comparison of clinical features between patients with positive DBE findings and those with negative findings.
Results:  Potential bleeding sources were discovered in 30 patients (69.8%) out of 43. Duration of bleeding was longer in patients with positive DBE findings than in those with negative findings (195 ± 311 vs 18 ± 17 days, P  = 0.015). Number of bleeding episodes was higher in patients with positive DBE findings (2.2 ± 1.2 vs 1.3 ± 0.5, P  = 0.011). The odds ratio for the detection of bleeding focus on DBE for patients with two or more bleeding episodes, relative to those with only one current bleeding episode was 5.67 (95% CI: 1.12–28.81, P  = 0.036) in multivariate analysis.
Conclusion:  DBE may be the most useful in patients with suspected small bowel bleeding if they have a history of frequent bleeding episodes over a long period.