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Prospective assessment of the diagnostic and therapeutic impact of small-bowel push enteroscopy.

BACKGROUND AND STUDY AIMS
Although the reported diagnostic yield of push enteroscopy has been substantial in previous studies, its clinical impact has never been prospectively evaluated. The primary aim of this study was to prospectively determine the diagnostic and therapeutic impact of enteroscopy. In addition, the yield of new and clinically important findings was prospectively assessed.


PATIENTS AND METHODS
Consecutive patients referred for enteroscopy were studied. The referring clinician completed a form indicating the working diagnosis, degree of diagnostic certainty, and the management plan had enteroscopy been unavailable. Diagnostic certainty was indicated on a scale of 1 = very unlikely (1 - 9 %) to 6 = certain (100 %). Following enteroscopy, the referring doctor completed another form indicating these features in the light of the enteroscopic findings.


RESULTS
The study group comprised 77 patients referred for 79 push enteroscopies. There was a change in working diagnosis or management plan as a result of enteroscopy in 39/77 (51 %) patients. The working diagnosis and the management plan changed in 29/77 (38 %) and 34/77 (44 %), respectively, and the diagnostic certainty changed in a further 29 patients (38 %). There were clinically significant small-bowel findings in 16 (20 %) and new upper gastrointestinal findings in 16 (20 %), giving an overall diagnostic yield of 40 %.


CONCLUSIONS
Enteroscopy has a significant impact on clinicians' working diagnoses and management plans.