Double-balloon endoscopy in the diagnosis and treatment of hemorrhage from retrovalvular angiodysplasias.

Acute rectal blood loss is a common problem that occurs most often in the elderly. The majority of the cases are caused by diverticular bleeding, while angiodysplasias account for about 8% of cases with gross rectal blood loss. Angiodysplasias in the colon are most often located in the caecum. They can cause severe colonic bleeding, sometimes even requiring multiple transfusions. Treatment of bleeding colonic angiodysplasias is usually done with argon plasma coagulation (APC). We describe two cases of elderly patients who presented with rectal blood loss, in whom gastroduodenoscopy and colonoscopy had not revealed a bleeding focus. Both patients were referred to our hospital for retrograde double balloon endoscopy as it was suspected that the bleeding focus was located in the distal small bowel. The flexible double-balloon endoscope allowed a better and easier inspection of the caecum and the ileocaecal valve (ICV). In both cases a large angiodysplasia was found on the back of the ICV. After treatment with APC the bleeding stopped and the haemoglobin levels remained within the normal range.

[Double-balloon enteroscopy for the diagnosis and treatment of patients with unexplained gastrointestinal blood loss]. / Dubbeleballon-enteroscopie bij de diagnostiek en de behandeling van patiënten met onverklaard gastro-intestinaal bloedverlies.

In 3 patients, 2 women aged 56 and 57 and a 65-year-old man, who presented with overt and occult gastrointestinal bleeding, no focus of the bleeding could be found during gastroscopy and colonoscopy. The patients were then examined and treated by double-balloon enteroscopy (DBE). DBE is a relatively new endoscopic technique that allows high-resolution visualisation of the entire small intestine with full endoscopic instrumentation. The 56-year-old woman had coeliac disease and an enteropathy-associated T-cell lymphoma with stenoses over approximately 150 cm of bowel length. She was given chemotherapy and responded well. The 57-year-old woman suffered from Rendu-Osler-Weber syndrome with multiple angiodysplasias in the small intestine. She was treated 5 times with argon plasma coagulation during DBE, for more than 40 angiodysplasias, and thereafter no longer needed blood transfusions. The 65-year-old man had a history of recurrent melanoma. During DBE, multiple metastases of a melanoma in the small intestine were found and tattooed. The tumours were later surgically excised, with no further metastases in the following 2 years. DBE has proven to be a good diagnostic and therapeutic tool in the management of small intestinal diseases.