Push enteroscopy in the era of capsule endoscopy

Goals: To evaluate the diagnostic yield of push enteroscopy in relation to indication and compare the yield in patients who had capsule endoscopy followed by push enteroscopy against capsule endoscopy naive patients. Background: With the advent of capsule endoscopy the role of push enteroscopy needs to be reevaluated. Study: Patients who underwent push enteroscopy from January 2002 to May 2006 were included. Results: One hundred fifty-five patients underwent push enteroscopy: 93 females, average age 55 years. There were 74 cases where both push enteroscopy (PE) and capsule endoscopy (CE) were performed. Indications for PE were iron deficiency anemia (n = 51), overt bleeding (n = 31), suspected celiac disease (n = 32), refractory celiac disease (n = 19), assessment for Crohn's disease (n = 10), and miscellaneous (n = 12). In 148 patients, an average length of 70 cm of small bowel was examined (range 30 to 130cm). PE was unsuccessful in 7 patients due to anatomic strictures or patient distress. The overall diagnostic yield was 30% with the highest yield in overt bleeding when compared with other subgroups (P < 0.001). Nine percent of lesions were within the reach of a standard endoscope. Comparison of the diagnostic yield in patients who had CE followed by PE against CE naive patients was 41% versus 47%, respectively (P < 1). There were no cases where push enteroscopy recognized a lesion that had not been already detected by capsule endoscopy. Conclusions: Push enteroscopy has the greatest diagnostic yield in patients with overt bleeding when compared with other referral indications. PE should be used as an adjuvant to CE for therapeutic intervention.