Аннотация:Aims:
Efficacy and safety of using laxatives for bowel preparation in patients with suspected small bowelbleeding is debating and challenging.
Methods:
From 14.02.2007 to 30.10.2017 there were 213 patients who admitted to our hospital with suspected intestinal bleeding (m-108, f-105, mean age 51.8 ± 18.3 years, range 17 – 89). There were 139 (65.2%) pts. with obscure overt and 74 (34.8%) with obscure occult bleeding. Urgent surgery was performed in 2 (0.9%) cases. Enteroscopy was performed in 211 (99.1%) pts. from which capsule enteroscopy (CE) was applied in 169 (79.3%) pts., balloon-assisted enteroscopy (BAE)- in 129 (60.5%) pts. We used PEG 4000 in 207 (97.1%) pts.(regimen of 2L before CE and peroral BAE; regimen 2+2L and 3+1L for transanal BAE); sodium phosphate- in 3 (1.4%) pts., PEG 3350- in 1 (0.4%) pt. for the small bowel preparation.
Results:
There were no signs of the recurrent bleeding during the preparation in all patients. We've seen continuation of bleeding in the course of the enteroscopy in 17 (12.2%) pts., but there were no clinical signs of bleeding during the preparation. The obvious source of GI bleeding was found in 178 (83.5%) from 213 patients: intestinal abnormalities were detected in 158 (74.8%) pts; the sources of bleeding in the upper/lower GI tract were revealed in 20 (9.3%) pts. No pathology was found in 35 (16.6%) pts. The sources of intestinal bleeding included vessel malformations in 61 (38.6%) cases, tumors – in 49 (31.0%) pts., enteropathy – in 41 (25.9%) pts, Meckel's diverticulum – in 5 (3.1%) pts., jejunum diverticula – in 2 (1.2%) pts. Endoscopic treatment was performed in 45 (21.3%) of 178 pts., surgical treatment- in 50 (23.7%) pts., conservative treatment- in 83 (39.3%) pts.
Conclusions:
PEG preparation for enteroscopy was safe and didn't provoke bleeding as well as any other adverse events. It made possible to improve visualization of intestine and clearly detect the source of bleeding.