Push-and-Pull Enteroscopy Best for Small-Bowel Bleeding

Technique gives better diagnostic yield and allows treatment to be carried out

FRIDAY, Sept. 29 (HealthDay News) -- When examining patients with suspected small-bowel bleeding, push-and-pull enteroscopy (PPE) gives a better diagnostic yield and enables more visualization of the small bowel compared with push enteroscopy, according to a report published in the September issue of the American Journal of Gastroenterology.

Andrea May, M.D., Ph.D., of the University of Mainz in Wiesbaden, Germany, and colleagues analyzed data from 52 patients with suspected mid-gastrointestinal bleeding who had undergone evaluation with both techniques.

PPE allowed far greater insertion depth (230 cm versus 80 cm) than push enteroscopy. And the technique gave a diagnosis in 38 out of 52 cases overall and in 33 cases as a result of oral PPE only, compared with only 23 cases for push enteroscopy. Using PPE yielded information on additional lesions deeper in the small intestine in 78 percent of push enteroscopy-positive patients. However, push enteroscopy was associated with lower sedoanalgesia, shorter examination times and less X-ray exposure. There were no relevant complications associated with either push enteroscopy or PPE.

"As the method [PPE] also allows endoscopic treatment to be carried out, PPE should always be considered before open surgery and intraoperative endoscopy in patients with mid-gastrointestinal bleeding," the authors conclude.

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