Prospective assessment of the diagnostic and therapeutic impact of small-bowel push enteroscopy.

BACKGROUND AND STUDY AIMS: Although the reported diagnostic yield of push enteroscopy has been substantial in previous studies, its clinical impact has never been prospectively evaluated. The primary aim of this study was to prospectively determine the diagnostic and therapeutic impact of enteroscopy. In addition, the yield of new and clinically important findings was prospectively assessed. PATIENTS AND METHODS: Consecutive patients referred for enteroscopy were studied. The referring clinician completed a form indicating the working diagnosis, degree of diagnostic certainty, and the management plan had enteroscopy been unavailable. Diagnostic certainty was indicated on a scale of 1 = very unlikely (1 - 9 %) to 6 = certain (100 %). Following enteroscopy, the referring doctor completed another form indicating these features in the light of the enteroscopic findings. RESULTS: The study group comprised 77 patients referred for 79 push enteroscopies. There was a change in working diagnosis or management plan as a result of enteroscopy in 39/77 (51 %) patients. The working diagnosis and the management plan changed in 29/77 (38 %) and 34/77 (44 %), respectively, and the diagnostic certainty changed in a further 29 patients (38 %). There were clinically significant small-bowel findings in 16 (20 %) and new upper gastrointestinal findings in 16 (20 %), giving an overall diagnostic yield of 40 %. CONCLUSIONS: Enteroscopy has a significant impact on clinicians' working diagnoses and management plans.

Low dose, short duration therapy for the eradication of Helicobacter pylori in patients with duodenal ulcer.

OBJECTIVE: To study the efficacy and acceptability of low dose, short duration triple therapy in eradicating Helicobacter pylori from patients with duodenal ulcer. DESIGN: A prospective study of 105 patients with H. pylori associated duodenal ulcer presenting consecutively to a regional Melbourne general hospital and a local private endoscopy clinic. INTERVENTIONS: Patients were treated with H2-antagonists (if required), followed by two weeks of triple therapy consisting of colloidal bismuth subcitrate (Denol) one tablet four times daily between meals, tetracycline hydrochloride 250 mg four times daily and metronidazole 400 mg twice daily. Four weeks, and again 12 months after treatment, patients were assessed by gastroscopy and antral biopsy for ulceration and H. pylori as measured by rapid urease test. Side effects of treatment were documented. RESULTS: Four patients withdrew because of drug side effects. Of 101 patients completing treatment, H. pylori was eradicated in 91 (90%, or 87% of total). Eight of the 10 patients in whom initial treatment failed received one or more further courses of triple therapy, with H. pylori being eradicated in five. Mild nausea occurred in 6% and possible candida infection in 3%. Of 68 patients who were reassessed after 12 months, 66 were still clear of H. pylori but, in four, small superficial ulcers were present. Two patients were positive for H. pylori, one with and one without ulceration, giving an H. pylori recurrence rate of 3% and an ulcer recurrence rate of 7%. CONCLUSIONS: This particular regimen of triple therapy was highly effective, safe and acceptable and could be offered to all patients with H. pylori associated duodenal ulcer.