Timing of enteroscopy in overt-obscure gastrointestinal bleeding - a systematic review and meta-analysis

Gastrenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal. Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho. Gastrenterology, Centro Hospitalar Vila Nova de Gaia/Espinho.

Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva. 2021
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Abstract
BACKGROUND The impact of early enteroscopy in the outcome of overt-obscure gastrointestinal bleeding (OGIB) is still not clear. Our aim is to evaluate the impact of early enteroscopy in overt-OGIB. METHODS Pubmed/(MEDLINE), Web of Science and Scopus were systematically reviewed. Observational retrospective studies comparing early versus non-early enteroscopy in overt-OGIB were identified. Data on diagnosis, treatment and rebleeding were extracted from each study and a meta-analysis was performed. RESULTS Fifteen studies (comprising 1907 patients) were included. Early enteroscopy was performed in 470 patients and non-early in 1437 patients. Early enteroscopy was associated with a significantly higher diagnostic (odds ratio=3.2, 95% C.I. 1.9,5.3, p=0.002) and therapeutic yield (odds ratio=4.9, 95% C.I. 1.2-20.5, p=0.03). However moderate and high heterogeneity was observed for both analyses (DY I2=60.4%; p=0.002; TY I2=83.1%; p<0.001). Considering only studies when enteroscopy was performed during ongoing-bleeding or within ≤24h, ≤48h and ≤72h from bleeding, the heterogeneity was removed, maintaining a positive effect on diagnostic yield (odds ratio=4.7, 95% C.I. 3.4,6.6, p<0.001, I2=0%). An early enteroscopy did not significantly influence the rebleeding rate (OR=0.87, 95% C.I. 0.40-1.89, p=0.72) in our analysis. CONCLUSIONS In conclusion, early enteroscopy, especially when performed in ongoing bleeding or within 24h, 48h and 72h of the bleeding episode, is able to increase the diagnostic yield. Although an effect on therapeutic yield was observed, the value of early intervention has to be cautiously evaluated due to high heterogeneity of results. In our meta-analysis, early enteroscopy did not significantly influence the rebleeding rate.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine