Pinho R1, Mascarenhas-Saraiva M2, Mão-de-Ferro S3, Ferreira S3, Almeida N4, Figueiredo P4, Rodrigues A5, Cardoso H6, Marques M6, Rosa B7, Cotter J8, Vilas-Boas G9, Cardoso C9, Salgado M10, Marcos-Pinto R10.
1ManopH, Instituto CUF, Portugal; Serviço de Gastrenterologia, Centro Hospitalar de Gaia/Espinho, Portugal.
2ManopH, Instituto CUF, Portugal.
3Serviço de Gastrenterologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Portugal.
4Faculdade de Medicina da Universidade de Coimbra, Portugal; Serviço de Gastrenterologia, Centro Hospitalar e Universitário de Coimbra, Portugal.
5Serviço de Gastrenterologia, Centro Hospitalar de Gaia/Espinho, Portugal.
6Serviço de Gastrenterologia, Centro Hospitalar de São João, Portugal.
7Serviço de Gastrenterologia, Centro Hospitalar do Alto Ave, Portugal.
8Serviço de Gastrenterologia, Centro Hospitalar do Alto Ave, Portugal; Instituto de Ciências da Vida e Saúde (ICVS), Escola de Ciências da Saúde, Universidade do Minho, Portugal; ICVS/3B's, Laboratório Associado, Braga/Guimarães, Portugal.
9Serviço de Gastrenterologia, Hospital Pedro Hispano, Portugal.
10Serviço de Gastrenterologia, Centro Hospitalar do Porto, Portugal.
ABSTRACT
Background
Device-assisted enteroscopies (DAEs) are recent endoscopic techniques that enable direct endoscopic small- bowel evaluation.
Objective
The objective of this article is to evaluate the implementation of DAEs in Portugal and assess the main indications, diagnoses, diagnostic yield, therapeutic yield and complication rate.
Methods
We conducted a multicenter retrospective series using a national Web-based survey on behalf of the Portuguese Small-Bowel Study Group. Participants were asked to fill out two online databases regarding procedural data, indications, diagnoses, endoscopic therapy and complications using prospectively collected institutional data records.
Results
A total of eight centers were enrolled in the survey, corresponding to 1411 DAEs. The most frequent indications were obscure gastrointestinal bleeding (OGIB), inflammatory bowel disease and small-bowel tumors. The pooled diagnostic yield was 63%. A relation between the diagnostic yield and the indications was clear, with a diagnostic yield for OGIB of 69% (p ¼ 0.02) with a 52% therapeutic yield. Complications occurred in 1.2%, with a major complication rate of 0.57%. Perforations occurred in four patients (0.28%).
Conclusion
DAEs are safe and effective procedures, with complication rates of 1.2%, the most serious of which is perforation. Most procedures are performed in the setting of OGIB. Diagnostic and therapeutic yields are dependent on the indication, hence appropriate patient selection is crucial.
