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The systematized approach to patients with small bowel bleeding (SBB) can reduce risks and costs for both patients and the Unified Health System (SUS).
Evaluate the evolution of the systematized approach to SBB in a regulated, hierarchically organized healthcare network of varying complexity.
Analysis of the medical records of patients with SBB treated at a tertiary, public, and teaching hospital in two distinct periods: before the implementation of a specialized service and algorithm for SBB (2001–2014, group without algorithm—GSA) and after the establishment of a trained, dedicated team, availability of capsule endoscopy and enteroscopy (2015–2023, group with algorithm—GCA). Demographic, clinical, and care-related data from 184 patient records were collected and entered into the REDCap platform. Additionally, a cost analysis was conducted.
Among the 184 patients, 82 (45%) were in the GSA group and 102 (55%) in the GCA group. The average number of specific exams per patient was 7.19 in GSA and 6.37 in GCA (p=0.02, p<0.05). Blood transfusions were performed in 64 patients (78.05%) in GSA and 68 patients (66.67%) in GCA (p=0.05). The average time to reach diagnosis was 309.9 weeks in GSA and 75.37 weeks in GCA (p<0.01). The average hospital stay was 7.57 weeks in GSA and 2.55 weeks in GCA (p<0.01). In GSA, 19 patients (23.2%) died due to SBB, while in GCA only six did (5.9%) (p=0.001, p<0.05). The average cost was higher compared to GCA (p<0.01).
The results of organizing a reference service for SBB care support are sufficient to subsidize the planning of services and regional healthcare networks.
The double balloon enteroscopy is an important method for the endoscopic approach of the small bowel that provides diagnosis and therapy of this segment’s disorders, with low complication rate.
Analysis of patients undergoing double balloon enteroscopy. The specific objectives were to establish the indications for this method, evaluate the findings by the double balloon enteroscopy, analyze the therapeutic options and the complications of the procedure.
It is a retrospective analysis of 65 patients who underwent double balloon enteroscopy.
Sixty-five procedures were performed in 50 patients, 63.1% were women and 36.9% were men. The mean age was 50.94 years. The main indication it was gastrointestinal bleeding, followed by abdominal pain and Crohn’s disease. Most procedures were considered normal. Polyps were the most prevalent finding, followed by angioectasias and duodenitis. In 49.2% of the cases, one or more therapeutic procedures were performed, (biopsy was the most prevalent). There was only one case of acute pancreatitis, which was treated clinically.
The enteroscopy is good and safe method for the evaluation of the small bowel, and its main indications are gastrointestinal bleeding and abdominal pain. It has low complications rates and reduces the necessity of surgery.
Desenvolvido por Surya MKT