Manejo endoscópico diagnóstico y terapeútico de la hemorragia digestiva media

Résumé

Abstract Mid-gastrointestinal bleeding (MGIB) is the first indication of capsule endoscopy (CE) and double-balloon enteroscopy (DBE). Both procedures have demonstrated to be useful in these patients achieving a similar diagnostic yield. However, there are many factors that may influence the agreement between both procedures. In addition, CE should be administered as first-line in most of cases. However, there are many specific situations of MGIB in which there is no consensus about the role of these techniques, such as massive overt-MGIB and malignant small bowel tumors (MSBT). In the present thesis, three articles analyzed the Morales Meseguer Hospital database. Patients in whom a CE and/or DBE was carried out between 2004 and 2014 were considered, with focus on clarifying the diagnostic agreement by type of lesion of both techniques and its role in the previously described situations. Although the degree ofdiagnosticagreement is similarbetween the CE and DBE,thiscan vary significantlyforeach type of lesion.The diagnosis agreement between CE and DBE according to the type of lesion is high in polyps, vascular lesions and tumors. The degree of agreement between both is low for Dieulafoy's lesion and bleeding without lesion identified.DBE may modify clinical outcome of patients with MSBT in up to 25% of cases by modifying or avoiding surgery. This procedure allows to identify the tumor location and characteristics, providing additional information that may influence further management. Vascular lesions and Dieulafoy's lesion usually located in proximal small bowel are one of the most frequent causes of recurrent severe overt-MGIB.Emergency DBE is an effective procedure in massive MGIB, finding lesions amenable to endoscopic therapy in most of cases. Combined approach with real-time by CE has shown to be effective as fist-line, being especially useful to determine the level of the bleeding and guiding further DBE route.