Obscure GI bleeding in the tropics: impact of introduction of double-balloon and capsule endoscopies on outcome

Background: Innovative but costly small-bowel enteroscopies, capsule endoscopy (CE), and double-balloon endoscopy (DBE) have revolutionized the management of obscure GI bleeding (OGIB).

Objective: To measure the impact of these procedures on outcomes of OGIB in a resource-poor setting.

Design: Prospective cohort study and comparison with a historical cohort.

Setting: Tertiary-care center in India.

Patients: Fifty-three patients with OGIB, diagnosed by American Gastroenterological Association criteria.

Interventions: DBE and/or CE were performed. Patients were then offered specific treatment and/or hematinics.

Main outcome measurements: The etiology of OGIB in a tropical country and yield of DBE and/or CE. The number of investigations required, follow-up hemoglobin, rebleeds, and interventions/transfusions needed were compared between the present and historical cohort.

Results: Mean age was 46.4 years with hemoglobin (mean +/- standard deviation) of 8.3 +/- 2.3 g/dL at evaluation. OGIB was overt in 33 and occult in 20. They underwent 173 investigations before referral. DBE and/or CE localized the source of bleeding in 43 (yield 81%). Angiodysplasias, tumors, Crohn's disease, intestinal tuberculosis, and hookworm infestation were predominant etiologies. Compared with the historical cohort, DBE and/or CE have reduced the number of investigations per patient, increased the yield of mid intestinal source of OGIB, and reduced the number of surgeries, especially emergency laparotomies. There was no significant alteration in the overall yield, mortality, and rebleeding rates.

Limitation: Small cohort without economic analysis.

Conclusions: The demographic profile and etiological spectrum of OGIB in the tropics is different. DBE and/or CE have made a favorable impact on management.