Prospective evaluation of the long-term outcomes after deep small-bowel spiral enteroscopy in patients with obscure GI bleeding

Background: Spiral enteroscopy can be safe and effective in the short term for evaluation of obscure GI bleeding, but long-term data are lacking. Objective: To assess the long-term clinical outcomes after deep small-bowel spiral enteroscopy performed for obscure GI bleeding. Design: Prospective cohort study. Setting: Academic referral center. Patients: This study included 78 patients who underwent antegrade spiral enteroscopy for evaluation of obscure GI bleeding. Intervention: Diagnostic spiral enteroscopy with hemostatic therapeutic maneuvers applied as indicated. Main Outcome Measurements: Postprocedure evidence of recurrent overt GI bleeding, blood transfusion requirements, need for iron supplementation, serum hemoglobin values, and the need for additional therapeutic procedures. Results: Long-term follow-up data (mean [± standard deviation] 25.3 ± 7.5 months; range 12.9-38.8 months) were obtained in 61 patients (78%). Among those with long-term follow-up data, overt bleeding before spiral enteroscopy was present in 62%, compared with 26% in the follow-up period (P <.0001). The mean (± SD) hemoglobin value increased from 10.6 ± 1.8 to 12.6 ± 1.9 g/dL (P <.0001). Blood transfusion requirements decreased by a mean of 4.19 units per patient (P =.0002), and the need for iron supplementation (P =.0487) and additional procedures (P <.0001) decreased in the follow-up period. There were 8 adverse events (9%) (7 mild, 1 moderate). Limitations: Single-center study, intervention bias. Conclusion: In patients with obscure GI bleeding, deep small-bowel spiral enteroscopy is safe and effective in reducing the incidence of overt bleeding. An increase in hemoglobin values along with a decrease in blood transfusion requirement, need for iron supplementation, and need for additional therapeutic procedures were found over long-term follow-up. (Clinical trial registration number: NCT00861263.)