Sa1638 A Meta-Analysis on Efficacy and Safety: Single-Balloon vs. Double-Balloon Enteroscopy
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Sa1637 Characteristics of the Small Bowel Lesions Detected by Capsule Endoscopy in Patients With Chronic Kidney Disease Harunobu Kawamura*, Eiji Sakai, Hiroki Endo, Eiji Yamada, Takuma Higurashi, Hidenori Ohkubo, Hirokazu Takahashi, Atsushi Nakajima Gastroenterology, Yokohama Coty University School of Medicine, Yokohama, Japan Background and Aims: Obscure gastrointestinal bleeding (OGIB) is one of the common complications in patients with chronic kidney disease (CKD), especially those who are on maintenance hemodialysis (HD). However, little is known about the characteristics of the small bowel lesions detectable by capsule endoscopy (CE) in these patients, or of the factors that could predict the presence of such lesions. Therefore we conducted a present study which investigating characteristics of the small bowel lesions detected by CE in CKD patients. Methods: A total of 42 CKD patients (including 19 patients on maintenance HD (HD patients) and 23 patients not on (non-HD patients)) and 132 age- and- sex adjusted non-CKD patients were the subjects of this study. The incidences of the small bowel vascular lesions and erosive/ulcerated lesions were compared among the groups. Furthermore, univariate and multivariate logistic-regression analyses were performed to identify predictive factors for the presence of small bowel lesions in the CKD patients. Results: The total diagnostic yield of CE was significantly higher in the CKD patients as compared to the non- CKD patients (64.2% and 44.7%, respectively, P 0.04). The incidence of vascular lesions was also significantly higher in the CKD patients compared to the non-CKD patients (47.6% and 20.5%, respectively, P 0.001), while the incidence of erosive/ulcerated lesions was not significantly different between the two patient groups (33.3% and 27.3%, respectively, P 0.45). On the other hand, there were no significant differences in the incidences of small bowel lesions between the HD patients and non-HD patients. In the CKD patients, past history of blood transfusion (OR 5.66; 95% CI 1.10 - 29.1, P 0.04) was identified as an independent predictor of the presence of vascular lesions, and history of low-dose aspirin use (OR 6.00; 95% CI 1.13 - 31.9, P 0.04) was identified as a predictor of the presence of erosive/ulcerated lesions. Conclusions: CE examination would be clinically meaningful for identifying the source of OGIB in CKD patients, especially patients with a history of recent blood transfusion and/or LDA use. Sa1638 A Meta-Analysis on Efficacy and Safety: Single-Balloon vs. Double-Balloon Enteroscopy Saurabh Sethi*, Douglas K. Pleskow, RAM Chuttani, Tyler M. Berzin, Mandeep Sawhney Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA Background: Double-balloon enteroscopy (DBE) and Single-balloon enteroscopy (SBE) are new techniques capable of deep enteroscopy. Results of individual studies comparing these two techniques have failed to identify a dominant strategy. Objectives: To systematically pool all available studies to compare the efficacy and safety of DBE with SBE for evaluation of the small bowel. Methods: Databases including PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched. Main outcome measures were complete small- bowel visualization, diagnostic yield, therapeutic yield, and complication rate. Statistical analysis was performed using Review Manager (RevMan version 5.0). Meta-analysis was performed using fixed effect or random-effect methods, depending on the absence or presence of significant heterogeneity. We used the 2 test to assess heterogeneity between trials and the I2 statistic to assess the extent of inconsistency. P 0.05 was defined as significant heterogeneity. Results were expressed as OR or mean difference with 95% CI. P 0.05 was considered statistically significant. Potential publication bias was examined by funnel plot. Results: Three prospective randomized controlled trials with a total of 268 patients were identified. DBE was superior to SBE for ability to visualize the entire small bowel (pooled OR 0.53 [95% CI: 0.28 to 0.98, p 0.04). DBE was superior to SBE for ability to provide endoscopic therapy (pooled OR 0.81 [95 % CI: 0.50 to 1.32, p0.4). DBE and SBE were similar with regard to ability to provide diagnosis (pooled OR 0.44 [95 % CI: 0.23 to 0.83, p 0.01). There was no significant difference between DBE and SBE, with regard to complication rate (pooled OR 1.12 [95 % CI: 0.06 to 19.28, p0.94). Conclusions: DBE was superior to SBE with regard to complete small bowel visualization and ability to provide treatment. DBE was similar to SBE with regard to diagnostic yield and complication rate. Sa1639 Is It Worth Pursuing Double Balloon Enteroscopy After Capsule Endoscopy in the Elderly? Findings From a Single Center Experience Victoria Gomez*, Michael J. Bartel, Mark E. Stark, Frank Lukens Gastroenterology, Mayo Clinic, Jacksonville, FL Introduction: The evaluation of obscure gastrointestinal bleeding and other suspected occult diseases of the small intestine involves use of capsule endoscopy (CE) and often times followed by double balloon enteroscopy (DBE). These two modalities are complimentary to each other with satisfactory diagnostic yield. However, DBE has procedureal related risks, and particularly in the very elderly patient population with naturally more co morbidities, has a presumed higher risk of adverse events. However, correlations between CE and DBE findings and overall outcomes of DBE are not well established in this older patient population. Aims: Primary aim was to determine the correlation between CE and DBE findings, followed by secondary aims of indications, findings and outcomes on DBE in the very elderly patient population defined by age 80 years. Methods: Review of a large prospectively collected DBE database from 2006 through November 2012. Patients’ demographics along with procedure indication, findings, and complications were recorded. The safety and diagnostic yield of DBE was calculated by frequency statistics. Correlation between findings on capsule endoscopy and DBE was analyzed. Results: During this study period, a total of 3100 DBE procedures were performed, for which 137 patients 80 Forrest plots comparing complete enteroscopy rate and diagnos- tic yield between SBE and DBE. Forrest plots comparing therapeutic yield and complication rate between SBE and DBE. Abstracts AB276 GASTROINTESTINAL ENDOSCOPY Volume 77, No. 5S : 2013 www.giejournal.org
Transcript of Sa1638 A Meta-Analysis on Efficacy and Safety: Single-Balloon vs. Double-Balloon Enteroscopy
Sa1637Characteristics of the Small Bowel Lesions Detected by CapsuleEndoscopy in Patients With Chronic Kidney DiseaseHarunobu Kawamura*, Eiji Sakai, Hiroki Endo, Eiji Yamada,Takuma Higurashi, Hidenori Ohkubo, Hirokazu Takahashi,Atsushi NakajimaGastroenterology, Yokohama Coty University School of Medicine,Yokohama, JapanBackground and Aims: Obscure gastrointestinal bleeding (OGIB) is one of thecommon complications in patients with chronic kidney disease (CKD), especiallythose who are on maintenance hemodialysis (HD). However, little is knownabout the characteristics of the small bowel lesions detectable by capsuleendoscopy (CE) in these patients, or of the factors that could predict thepresence of such lesions. Therefore we conducted a present study whichinvestigating characteristics of the small bowel lesions detected by CE in CKDpatients. Methods: A total of 42 CKD patients (including 19 patients onmaintenance HD (HD patients) and 23 patients not on (non-HD patients)) and132 age- and- sex adjusted non-CKD patients were the subjects of this study. Theincidences of the small bowel vascular lesions and erosive/ulcerated lesionswere compared among the groups. Furthermore, univariate and multivariatelogistic-regression analyses were performed to identify predictive factors for thepresence of small bowel lesions in the CKD patients. Results: The total diagnosticyield of CE was significantly higher in the CKD patients as compared to the non-CKD patients (64.2% and 44.7%, respectively, P � 0.04). The incidence ofvascular lesions was also significantly higher in the CKD patients compared tothe non-CKD patients (47.6% and 20.5%, respectively, P � 0.001), while theincidence of erosive/ulcerated lesions was not significantly different between thetwo patient groups (33.3% and 27.3%, respectively, P � 0.45). On the otherhand, there were no significant differences in the incidences of small bowellesions between the HD patients and non-HD patients. In the CKD patients, pasthistory of blood transfusion (OR 5.66; 95% CI 1.10 - 29.1, P � 0.04) wasidentified as an independent predictor of the presence of vascular lesions, andhistory of low-dose aspirin use (OR 6.00; 95% CI 1.13 - 31.9, P � 0.04) wasidentified as a predictor of the presence of erosive/ulcerated lesions.Conclusions: CE examination would be clinically meaningful for identifying thesource of OGIB in CKD patients, especially patients with a history of recentblood transfusion and/or LDA use.
Sa1638A Meta-Analysis on Efficacy and Safety: Single-Balloon vs.Double-Balloon EnteroscopySaurabh Sethi*, Douglas K. Pleskow, RAM Chuttani, Tyler M. Berzin,Mandeep SawhneyDivision of Gastroenterology, Beth Israel Deaconess Medical Centerand Harvard Medical School, Boston, MABackground: Double-balloon enteroscopy (DBE) and Single-balloon enteroscopy(SBE) are new techniques capable of deep enteroscopy. Results of individualstudies comparing these two techniques have failed to identify a dominantstrategy. Objectives: To systematically pool all available studies to compare theefficacy and safety of DBE with SBE for evaluation of the small bowel. Methods:Databases including PubMed, Embase, and the Cochrane Central Register ofControlled Trials were searched. Main outcome measures were complete small-bowel visualization, diagnostic yield, therapeutic yield, and complication rate.Statistical analysis was performed using Review Manager (RevMan version 5.0).Meta-analysis was performed using fixed effect or random-effect methods,depending on the absence or presence of significant heterogeneity. We used the�2 test to assess heterogeneity between trials and the I2 statistic to assess theextent of inconsistency. P � 0.05 was defined as significant heterogeneity.Results were expressed as OR or mean difference with 95% CI. P � 0.05 wasconsidered statistically significant. Potential publication bias was examined byfunnel plot. Results: Three prospective randomized controlled trials with a totalof 268 patients were identified. DBE was superior to SBE for ability to visualizethe entire small bowel (pooled OR� 0.53 [95% CI: 0.28 to 0.98, p �0.04). DBEwas superior to SBE for ability to provide endoscopic therapy (pooled OR �0.81 [95 % CI: 0.50 to 1.32, p�0.4). DBE and SBE were similar with regard toability to provide diagnosis (pooled OR� 0.44 [95 % CI: 0.23 to 0.83, p� 0.01).There was no significant difference between DBE and SBE, with regard tocomplication rate (pooled OR 1.12 [95 % CI: 0.06 to 19.28, p�0.94). Conclusions:DBE was superior to SBE with regard to complete small bowel visualization andability to provide treatment. DBE was similar to SBE with regard to diagnosticyield and complication rate.
Sa1639Is It Worth Pursuing Double Balloon Enteroscopy After CapsuleEndoscopy in the Elderly? Findings From a Single CenterExperienceVictoria Gomez*, Michael J. Bartel, Mark E. Stark, Frank LukensGastroenterology, Mayo Clinic, Jacksonville, FLIntroduction: The evaluation of obscure gastrointestinal bleeding and othersuspected occult diseases of the small intestine involves use of capsuleendoscopy (CE) and often times followed by double balloon enteroscopy (DBE).These two modalities are complimentary to each other with satisfactorydiagnostic yield. However, DBE has procedureal related risks, and particularly inthe very elderly patient population with naturally more co morbidities, has apresumed higher risk of adverse events. However, correlations between CE andDBE findings and overall outcomes of DBE are not well established in this olderpatient population. Aims: Primary aim was to determine the correlation betweenCE and DBE findings, followed by secondary aims of indications, findings andoutcomes on DBE in the very elderly patient population defined by age �� 80years. Methods: Review of a large prospectively collected DBE database from2006 through November 2012. Patients’ demographics along with procedureindication, findings, and complications were recorded. The safety and diagnosticyield of DBE was calculated by frequency statistics. Correlation between findingson capsule endoscopy and DBE was analyzed. Results: During this study period,a total of 3100 DBE procedures were performed, for which 137 patients �� 80
Forrest plots comparing complete enteroscopy rate and diagnos-tic yield between SBE and DBE.
Forrest plots comparing therapeutic yield and complication ratebetween SBE and DBE.
Abstracts
AB276 GASTROINTESTINAL ENDOSCOPY Volume 77, No. 5S : 2013 www.giejournal.org
