Diagnostic yield of push enteroscopy in the investigation of small bowel disease

SUMMARY Aim: To assess the diagnostic value of push-type videoenteroscopy in the investigation of small bowel disease. Patients and methods: From January 1994 to November 2000, 235 consecutive patients underwent push-type enteroscopy, using the Pentax, VSB 2900 video enteroscope. Indications for enteroscopy were: unexplained iron deficiency anaemia (n=59); macroscopic gastrointestinal bleeding (n=49); abnormal small bowel radiology (n=12); chronic diarrhoea and/or malabsorption (n=81); abdominal pain (n=22); suspected neoplasia (n=7) and polyposis syndromes (n=5). Results: The median depth of small intestine intubated was 80 cm past the ligament of Treitz, (range 20-160cm). Procedure time varied from 15-45 minutes. Tolerance of the examination was good for all patients and there were no complications. In patients with anaemia and/or gastrointestinal bleeding, underlying pathology was detected in 64/108 patients (59%), while 19/108 patients (17.5%) had diagnostic findings located in the upper gastrointestinal tract. In those with abnormal small bowel radiology, abnormal findings were diagnosed or excluded as artifacts in 11/12 patients (91%). In those with diarrhea and/or malabsorption a definite diagnosis was made in 28/81 patients (34.5%). In patients with abdominal pain, abnormalities were detected in 3/22 patients (13.5%). Finally, in patients with Peutz- Jeghers syndrome push enteroscopy proved very sensitive in detecting jejunal polyps. Conclusion: Push-type enteroscopy is a quick and examination. Even though endoscopic exploration restricted to the jejunum, it is efficacious in clinical practice and provides valuable diagnostic information in investigation of patients with small bowel disease.