Push and sonde enteroscopy for the diagnosis of obscure gastrointestinal bleeding.

OBJECTIVE: The combination of push and sonde enteroscopy permits endoscopic evaluation to extend the distal small bowel. Our objective was to determine the yields of both push and sonde enteroscopy in patients with obscure GI bleeding.
METHODS: We retrospectively reviewed 553 small bowel examinations performed with an orally passed 135-cm pediatric colonoscope in combination with a 2750-cm per nasal sonde enteroscope to investigate the small bowel for sources of gastrointestinal bleeding of obscure origin.
RESULTS: The examination reached the distal jejunum or beyond in over 90% of patients undergoing both push and sonde enteroscopy. The yield of these combined studies was 58% for identifying a possible source of gastrointestinal blood loss. In 40% of the examinations, the abnormality was found distal to the limits of routine upper gastrointestinal endoscopy. In 26% of all examinations, the lesion was detectable only by sonde enteroscopy. The most common small bowel findings were mucosal vascular lesions (31% of all exams) and tumors (6%). No major endoscopic complications occurred, and patients tolerated the procedures well.
CONCLUSIONS: The combination of push and sonde enteroscopy is a valuable tool in the evaluation of obscure gastrointestinal bleeding and may provide useful information necessary to formulate treatment plans aimed at cessation of bleeding.