The Guide Significance Of The Clinical Characteristics Of The Obscure Gastrointestinal Bleeding In Selecting The Best Route Of Insertion For The Balloon Assisted Enteroscopy

Background and objective:Obscure gastrointestinal bleeding (OGIB) is defined as recurrent gastrointestinal bleeding when conventional imaging modalities such as gastroscope, colonoscopy, small bowel follow-through(SBFT), mesenteric angiography remains undiagnosed. Most OGIB events are attributed to small bowel diseases. The etiological diagnosis of OGIB has always been clinical difficult point, because of anatomical characteristics of the small bowel of tedious, circuitous and position depth. The diagnosis of OGIB has been acquired an obvious advance since the invention and the extensive use of balloon assisted enteroscopy (BAE) which consists of single balloon enteroscopy (SBE) and double balloon enteroscopy (DBE). How to improve the detection rate of small bowel diseases with BAE remains further research, since the operation of BAE has a higher degree of difficulty comparing with gastroscope and the colonoscopy, besides, most cases cannot attain observation of the whole small bowel. The article mainly discusses the clinical application value of improving the positive detection rate of OGIB by the clinical characteristics of patients with OGIB in selecting the best route of insertion for the BAE.Methods:Data of 222 inpatients with OGIB from Air Force General Hospital who underwent BAE from September 2003 to March 2015 were retrospectively analyzed. They were classified into two groups based on the first insertion route:anterograde approach and retrograde approach. Record the patients’ general clinical characteristics in two groups respectively such as gender, age, amount of bleeding, decline level of Hb, especially the initial change of color of stools during the bleeding, for example, positive fecal occult blood test (FOBT), puce, cinereus, tarry, black red (see the red color when flush the toilet), maroon-colored and bright red. Analyse the relevance between the color of stools with the positive detection rate through different BAE approach among patients with OGIB. All data were analyzed statistically by SPSS 17.0. Measurement data adopt m±SD and rates of the groups were compared with χ2 text. The difference would be significance if P<0.05.Results:222 cases with OGIB received the inspection of BAE,130 cases found the lesions and the total detection rate was 58.56%(130/222). There has no significance in gender, age, amount of bleeding and the decline level of hemoglobin within the two groups (P>0.05). Patients with melena especially with tarry stools have a higher diagnostic yield with transoral approach (76.47% vs 38.46%), while patients with maroon-colored stools or bright red stools better choose transanal approach, which both have a significant difference (detection rate is 76.19% vs21.43% or 91.30% vs 25.0% respectively)(P<0.05). But few patients with maroon-colored stools or bright red stools couldn’t find any lesions with transanal approach, the same as few patients with tarry stools couldn’t find any lesions with transoral approach. At this time, some patients also could find the abnormal through two approach to finish the examination of the whole small bowel. However, there has no significance in choosing anterograde approach and retrograde approach among patients with positive fecal occult blood test, puce, cinereus and black red stools (detection rate is 40.0% vs 53.85%、66.67% vs 61.54%、53.33% vs 63.64%、30.0% vs 54.55% respectively) (P>0.05). In this condition, we will continue with the inspection through the opposite insertion when the primal inspection couldn’t detect the reason of bleeding. 222 patients with OGIB all finished the inspection of BAE successfully without bleeding, perforating and other serious complications during and after the inspection.Conclusion:The article uses the visual data to prove that the color of stools can be an important reference proof in choosing the best route of insertion during the inspection of BAE in patients with OGIB.Patients with melena better choose transoral approach, while maroon-colored stools or bright red stools choose transanal approach at first. Patients with positive fecal occult blood test, puce, cinereus and black red stools need inspections through transoral approach and transanal approach to find the lesions.