7031 Clinical impact of upper and lower enteroscopy.

Aim: To assess the clinical benefit of gastrointestinal tract enteroscopy. Methods: Between august 98 and october 99, 28 patients (16 men, 12 women), mean age: 51.5 (20-81 years) were admitted for upper and lower enteroscopy. In these 28 patients, indications were the followings: Iron deficiency anemia (n=20, mean rate of hemoglobina: 6.6 g/dl (4-11)) with (n=8; hematemesis n=1, melena n=7) or without macroscopic haemorrhages (n=12), abdominal pain (n=8). Results: Upper enteroscopy was performed in 25/28 patients (89%) and considered as sufficient by operator in 23 cases (92%). Twenty patients underwent lower enteroscopy (71.4%): satisfactory progression in 13 patients (65%), incomplete in 4 (20%) and no progression beyond caecum due to an irreducible loop in 3 cases (15%). Enteroscopy was normal in 15 cases (53.6%). In the 13 remaining patients (46.4%), findings were: angiomatous lesions (n=5: jejunal (n=2), colonic (n=3)), malignant tumours (n=2: jejunal adenocarcinomas including a HNPCC syndrom), jejunal benign tumours (n=2: moderate dysplasiaadenomas including one patient with Gardner syndrom), ulcerative gastric lesion (n=3: fundus ulcer (n=2), antral erosion (n=1)) missed by gastrocopy, intestinal lipomatosis (n=1). Lesions were diagnosed in 4/8 (50%) and 9/12 (75%) patients who had respectively anemia with or without macroscopic haemorrhages. Enteroscopy showed lesion strictly limited to the small intestine only in 6 cases (21.4%). A treatment was performed in 9 cases (32.1%): jejunal carcinoma resection (n=1), polypectomy (n=2), endoscopic electrocoagulation (n=3), antisecretory treatment without bleeding recurrence (n=3). Conclusion: Enteroscopy is useful for exploration of occult gastrointestinal bleeding. A therapeutic management was performed in one third of patients.