Clinical characteristics and prognosis of emergency enteroscopy for small bowel bleeding in hospitals of different levels: A real-world study based on 297 cases from provincial, municipal, and district hospitals

Abstract Background and aims: This study aimed to compare the clinical characteristics, diagnostic efficiency, lesion detection spectrum, and follow-up outcomes of emergency enteroscopy for obscure small bowel bleeding among provincial, municipal, and district hospitals. Methods: This was a multicenter retrospective analysis of 297 consecutive patients who underwent emergency enteroscopy for obscure small bowel bleeding at a provincial hospital (n = 240), a municipal hospital (n = 25), and a district hospital (n = 32). Baseline data, ward type on admission, pre-procedural examinations, enteroscopy completion rate (total enteroscopy), endoscopic diagnoses, treatment modalities, complications, and follow-up data were collected and compared. Results: The provincial hospital admitted the highest proportion of patients to the intensive care unit (ICU) (21.3%) and performed more comprehensive pre-procedural examinations. The total enteroscopy completion rate was significantly higher at the provincial hospital (87.92%) than at the municipal (68.0%) and district (46.88%) hospitals. In terms of disease spectrum, the provincial hospital predominantly managed Crohn’s disease (33.3%), Meckel’s diverticulum (16.7%), and small bowel vascular malformations (12.5%), whereas municipal and district hospitals showed a narrower disease spectrum. Endoscopic therapy was the most common treatment across all levels. Follow-up data indicated that the provincial hospital had a lower rebleeding rate and better long-term prognosis. Among cases of incomplete enteroscopy, “bowel loop tortuosity” was a significantly more frequent cause of failure at the municipal and district hospitals. Conclusions: Significant differences exist in the diagnostic and therapeutic capacity of emergency enteroscopy and patient composition across hospital levels. Provincial hospitals demonstrate clear advantages in procedural efficiency, lesion detection, and treatment outcomes. Establishing standardized care pathways for small bowel bleeding and strengthening technical support for primary hospitals are crucial for improving overall clinical care.