Clinical Application Of DBE In The Elderly Population And Its Diagnostic Analysis Of Small Intestine Tumors

Background and objective Double-balloon enteroscopy(DBE)is widely used around the world.But the comparison of diagnostic yields between the adults and the elderly is still scares.To compare the diagnostic yields and safety of DBE in obscure gastrointestinal bleeding and incomplete small bowel obstruction between the adults and the elderly.To determine the characteristics of small bowel tumors(SBTs)in patients underwent double balloon endoscopy(DBE)and to compare the clinical value of DBE with other diagnostic tools.Methods We retrospectively reviewed the patients underwent DBE from March 2008 to July 2018 with the indications of obscure gastrointestinal bleeding or incomplete small bowel obstruction in Ruijin Hospital and divided them into Adults(age 18-64)and Elderly(age ?65).The clinical characteristics,diagnostic yields and postoperative complications were collected and further analyzed.A retrospective study was conducted in patients underwent DBE procedures from March 2008 to April 2017.The demographic,clinical and pathological characteristics of patients with SBTs were recorded.Results The first part recorded that eight hundred and seventyseven DBEs were performed,with 729 in Adults group and 148 in Elderly group.In patients with OGIB,Meckel's diverticulum in Adults was significantly more than those in Elderly(4.6% vs 0.9%)(P=0.032).Angioectasia was more seen in Elderly than in Adults(25.9% vs 17.9%)(P=0.048).In patients with incomplete small bowel obstruction,those in Elderly group were more likely to have adenocarcinoma(19.4% vs 7.1%)(P=0.038).Patients in Adults were more tended to have Crohn's disease(23.4% vs 8.3%)(P=0.045).Most of the post-operative complications were mild.Adults and Elderly groups displayed comparable tolerance to DBE(P>0.05,respectively).In the second part,one thousand one hundred and two patients(761 males,range 3-85 years)were enrolled in this study,with 1140 procedures completed in total.99/1102 patients(9.0%)had SBTs,including benign polyps(20,20.2%),gastrointestinal stromal tumors(GISTs)(24,24.2%),lymphomas(13,13.1%),adenocarcinoma(39,39.4%),and neuroendocrine tumors(3,3.0%).The most common clinical symptom for benign polyps was obscure gastrointestinal bleeding(OGIB)(75.0%).But among patients with malignant SBTs,the main indication for DBE was chronic abdominal pain(43.8%),followed by OGIB(36.3%),vomit(10.0%),abnormal images(6.3%)and diarrhea(3.8%)(P<0.001).Moreover,SBTs were primarily located in the jejunum alone(40/99,40.4%).DBE had better sensitivity(89.2%),specificity(95.2%),positive predictive value(PPV)(90.0%),and negative predictive value(NPV)(94.8%)than other tools for suspected SBTs.Conclusion1.DBE has high diagnostic yield in small bowel disorders with slightly different disease spectrum between adult and elderly.2.DBE could be well-tolerated in the elderly.3.Small bowel tumor is mainly located in jejunum and with OGIB and abdominal pain as major complaints.4.DBE is a reliable method for the diagnosis of SBTs compared with other diagnostic tools.