Year 2021 / Volume 113 / Number 9
Review
Timing of enteroscopy in overt-obscure gastrointestinal bleeding: a systematic review and meta-analysis

656-669

DOI: 10.17235/reed.2021.7976/2021

Catarina Gomes, Rolando Pinho, Ana Ponte, Maria Manuela Estevinho, João Carvalho,

Abstract
Background: the impact of early enteroscopy on the outcome of overt-obscure gastrointestinal bleeding (OGIB) is still unclear. Our aim was to evaluate the impact of early enteroscopy on overt-OGIB. Methods: the PubMed-MEDLINE, Web of Science, and Scopus databases 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 1,907 patients) were included. Early enteroscopy was performed in 470 patients and non-early enteroscopy in 1,437 patients. Early enteroscopy was associated with a significantly higher diagnostic yield (odds ratio [OR] = 3.2, 95 % CI: 1.9-5.3; p = 0.002) and therapeutic yield (OR = 4.9, 95 % CI: 1.2-20.5; p = 0.03). However, moderate and high heterogeneity was observed in both analyses (DY I2 = 60.4 %; p = 0.002; TY I2 = 83.1 %; p < 0.001). When considering only studies where enteroscopy was performed during ongoing bleeding or within ≤ 24 h, ≤ 48 h, and ≤ 72 h of bleeding, heterogeneity was removed while the positive effect on diagnostic yield was maintained (OR = 4.7, 95 % CI: 3.4-6.6, p < 0.001, I2 = 0 %). Early enteroscopy did not significantly influence rebleeding rate (OR = 0.87, 95 % CI: 0.40-1.89, p = 0.72) in our analysis. Conclusions: in conclusion, early enteroscopy, especially when performed during ongoing bleeding or within 24 h, 48 h or 72 h of the bleeding episode, may increase diagnostic yield. Although an effect on therapeutic yield was observed, the value of early intervention has to be cautiously evaluated due to the high heterogeneity found among results. In our meta-analysis, early enteroscopy did not significantly influence rebleeding rate.
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25/10/2022 17:05:51
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Gomes C, Pinho R, Ponte A, Estevinho M, Carvalho J. Timing of enteroscopy in overt-obscure gastrointestinal bleeding: a systematic review and meta-analysis. 7976/2021


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Publication history

Received: 15/03/2021

Accepted: 23/05/2021

Online First: 01/06/2021

Published: 07/09/2021

Article revision time: 65 days

Article Online First time: 78 days

Article editing time: 176 days


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