Double-Balloon Enteroscopy-detected Lipid Islets in the Small Bowel are Strong Predictors of Cardiovascular Disease when associated with Angiectasia and Bleeding
download Full Article (PDF file)
Heinz Albrecht, Wolfgang H. Hagel, Alexander F. Hagel, Markus F. Neurath, Martin Raithel
Department of Medicine 1, Gastroenterology and Interventional Endoscopy, University of Erlangen-Nuremberg,
Background & Aims: Double-balloon enteroscopy (DBE) is a sensitive and safe procedure for the detection and treatment of mid-gastrointestinal bleeding (MGIB). It combines the possibility of a panenteroscopy with the immediate chance for intervention. This study evaluates the yield of DBE for the detection and treatment of MGIB in an unselected patient cohort.
Methods: In a five-year period a total of 119 DBEs were carried out on 62 patients due to MGIB. Inclusion criteria were hematochezia, melena, anemia, positive hemoccult-test and iron deficiency. All pre-existing diseases or comorbidities were evaluated. Two main statistical methodologies were used in data analysis: descriptive statistics to describe the basic features of our data and Fisher’s exact test for comparisons of proportions.
Results: The diagnostic yield was 69% (pathological findings in 43/62 patients) and the main diagnoses in all DBE-procedures were angiodysplasia (22%, 26/119 DBE), followed by lipid islets (18%, 21/119 DBE). In all patients with lipid islets this diagnosis was significantly connected with cardiovascular diseases. The combination of lipid islets and a relevant bleeding source appeared in 79% of the 19 patients with these findings. Of these, 53% had to be treated due to the bleeding event. The overall therapeutic intervention rate was 58%. Serious complications such as perforation or pancreatitis did not occur.
Conclusion: Double-balloon enteroscopy as the gold standard for small bowel investigation in MGIB confirmed its high diagnostic yield in an unselected cohort of patients. A new strong combination of lipid islets with cardiovascular disease was revealed, with a high incidence of angiectasia bleeding. This combination should be evaluated in more detail as a new risk factor for MGIB, and should be regarded in this population when therapeutic anticoagulation is needed.
Key words: double-balloon enteroscopy (DBE) – obscure gastrointestinal bleeding – lipid islets – cardiovascular disease.
Abbreviations: APC: argon plasma coagulation; CE: capsule endoscopy; DBE: double-balloon enteroscopy; EGD: esophagogastroduodenoscopy; ERCP: endoscopic retrograde cholangio-pancreatography; MGIB: mid-gastrointestinal bleeding; OGIB: obscure gastrointestinal bleeding; PE: push enteroscopy.