Double balloon enteroscopy: a leap forward for the gastroent

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Double balloon enteroscopy: a leap forward for the gastroent

Postby patoco » Fri Jun 22, 2007 2:24 pm

Early experience with double balloon enteroscopy: a leap forward for the gastroenterologist.

Singapore Med J. 2007

Ang D, Luman W, Ooi CJ.
Department of Gastroenterology and Hepatology, Singapore General Hospital, Outram Road, Singapore 169608.

INTRODUCTION: Double balloon enteroscopy (DBE) is a novel procedure that allows complete visualisation, biopsy and treatment of small intestinal disorders. We describe our early experience with the use of DBE, evaluating the indications, diagnostic rates and complications. A secondary aim of the study was to compare the findings from DBE with wireless capsule endoscopy (WCE).

METHODS: Retrospective study of patients referred to the Department of Gastroenterology and Hepathology at the Singapore General Hospital for evaluation of suspected small bowel diseases between February 2005 and May 2006 was done. A total of 34 procedures were conducted on 30 patients. A standardised data collection form was used.

RESULTS: DBE was carried out via the oral approach (19 patients), anal approach (eight patients), and both approaches (three patients). Mean age was 53 (range 16-79) years. 12 procedures (35.3 percent) had one endoscopist and 22 (64.7 percent) procedures had two.

The overall diagnostic input from DBE was 73.3 percent (22 of 30 patients). A positive diagnosis was achieved in 19 patients: jejunal gastrointestinal stromal tumour (GIST) (one), jejunal sarcoma (one), jejunal adenocarcinoma (one), duodenal adenocarcinoma (one), malignant lymphangioma (one), eosinophilic enteritis (one), pseudomembranous ileitis (one), tuberculous ileitis (one), jejunitis/ileitis (seven), lymphangiectasia attributed to relapsed Non-Hodgkins lymphoma (one), combination of angiodysplastic lesions and apthous jejunal/ileal lesions (one), and focal villous atrophy (two). Small intestinal pathology was excluded in three patients with abnormal computed tomography (CT) findings.

Endoscopy time for antegrade DBE was 46.1 (+/- 20.1) minutes and for retrograde DBE was 70.8 (+/- 11.0) minutes. The findings of WCE correlated with DBE findings in nine of 12 (75 percent) patients. Apart from the first three DBE procedures, all subsequent cases were performed without fluoroscopy. When stratified into antegrade and retrograde DBEs respectively, procedural duration, sedative use and diagnostic yield were comparable for one and two endoscopist DBEs. No complications were recorded.

CONCLUSION: Our early experience with DBE shows it to be safe and effective in imaging the small intestine, and it may soon become a standard mode of investigation for the gastroenterologist.

Full Text Article

http://www.sma.org.sg/smj/4801/4801a8.pdf

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The role of capsule endoscopy combined with double-balloon enteroscopy in diagnosis of small bowel diseases.

Li XB, Ge ZZ, Dai J, Gao YJ, Liu WZ, Hu YB, Xiao SD.
Department of Gastroenterology, Renji Hospital, Medical College of Shanghai Jiaotong University, Shanghai Institute of Digestive Diseases, Shanghai 200001, China.

Keywords: capsule endoscopy·double-balloon enteroscopy·small intestinal disease·obscure gastrointestinal bleeding

BACKGROUND: The diagnosis of small bowel diseases remains relatively inefficient using traditional imaging techniques. Capsule endoscopy (CE) and double-balloon enteroscopy (DBE) are two novel methods of enteroscopy for examining the entire small bowel. The aim of this study was to evaluate the detection rate and diagnostic accuracy of CE and DBE in patients with suspected small bowel diseases and to investigate the clinical significance of combined use of these two novel modalities.

METHODS: Two hundred and eighteen patients were evaluated for suspected small bowel disease, including 116 with obscure gastrointestinal bleeding and 102 with obscure abdominal pain or chronic diarrhea. One hundred and sixty-five out of these patients underwent CE first and 53 patients underwent DBE (under anesthesia with propofol) first. DBE was recommended after negative or equivocal evaluation on CE and vise versa. Introduction of the endoscope during DBE was either orally or anally and the patients were referred for a second procedure using the opposite route several days later when no abnormalities were found on the first procedure. The detection rates, diagnostic accuracy, tolerance and frequency of adverse events of these two modalities were then analyzed.

RESULTS: Failure of the procedure was seen in one patient with CE and in two patients with DBE. Sixty-four DBE procedures were carried out in 51 patients; by the oral route in 34 cases, the anal route in 4 and both routes in 13 cases. The overall detection rate of small bowel diseases using CE (72.0%, 118/164) was superior to that with DBE (41.2%, 21/51); chi(2) = 16.1218, P < 0.0001. The diagnostic rate (51.8%, 85/164) was also higher than that with the latter procedure (39.2%, 20/51), but was not significantly different (chi(2) = 2.4771, P > 0.05). Furthermore, the detection rate of small bowel diseases in patients with obscure gastrointestinal bleeding using CE (88.0%, 88/100) was superior to that of DBE (60.0%, 9/15); chi(2) = 7.7457, P = 0.0054. Lesions were detected by DBE in 1 out of 4 patients in whom CE had a negative result. Suspected findings by CE were confirmed by DBE combined with biopsy in 12 out of 15 patients. On the other hand, small bowel lesions were identified by CE in all 3 patients after negative evaluations by DBE. There were no severe complications during or after either of the two procedures.

CONCLUSIONS: The detection rate of small bowel diseases by CE is very high. CE should be selected for the initial diagnosis in patients with suspected small bowel diseases, especially in patients with obscure gastrointestinal bleeding. DBE appears to be inferior to CE in the diagnosis of small bowel diseases. However, it was shown that abnormalities could still be identified by DBE in patients with normal images or used to confirm suspected findings from CE. DBE can also serve as a good complementary approach after an initial diagnostic imaging using CE.

Full Text Article

http://www.cmj.org/Periodical/paperlist ... ype=pubmed

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Diagnostic and therapeutic impact of double-balloon enteroscopy.

Endoscopy. 2006

Mönkemüller K, Weigt J, Treiber G, Kolfenbach S, Kahl S, Röcken C, Ebert M, Fry LC, Malfertheiner P.
Division of Gastroenterology, Hepatology and Infectious Diseases, Dept. of Pathology, Otto von Guericke University, Magdeburg University Hospital, Magdeburg, Germany. Klaus.Moenkemueller@medizin.uni-magdeburg.de

BACKGROUND AND STUDY AIMS: Double-balloon enteroscopy (DBE) is a new endoscopic method for examining the small intestine. Most reports of DBE have been from Japan, and very few data on this new technique have been reported by centers outside Japan. The aim of the present study was to determine the diagnostic yield of DBE, measure the frequency of management changes made on the basis of the results, and evaluate the clinical outcome for patients undergoing the procedure.

PATIENTS AND METHODS: All patients undergoing DBE using a Fujinon enteroscope (length 200 cm, diameter 8 mm) during a 11-month period were studied. All of the patients had previously undergone esophagogastroduodenoscopy and colonoscopy. They underwent small-bowel cleansing on the day before the procedure using a standard colon lavage solution.

RESULTS: Seventy DBE procedures were carried out in 53 patients (34 men, 19 women; mean age 60 years, range 24 - 80) by the oral route in 46 cases and the anal route in 24. The indications for the examination were gastrointestinal bleeding (n = 29), suspected Crohn's disease (n = 6), abdominal pain (n = 4), polyp removal or evaluation in polyposis syndromes (n = 6), chronic diarrhea (n = 4), and surveillance or tumor search (n = 4). The mean duration of the procedure was 72 min (range 25 min - 3 h). The mean radiation exposure was 441 dGy/cm (range 70 - 1462), and the mean depth of small-bowel insertion was 150 cm (range 1 - 470 cm). It was possible to evaluate the entire small bowel in four patients (8 %). A new diagnosis was obtained in 26 of the 53 patients (49 %). The findings in the 70 procedures were angiodysplasia (n = 13), ulcerations or erosions (n = 5), jejunitis or ileitis (n = 5), tumors (n = 5), stenosis (n = 4), polyps (n = 5), lymphangiectasias (n = 4), Crohn's disease (n = 4), and normal (n = 17). DBE resulted in a therapeutic intervention (endoscopic, medical or surgical, excluding blood transfusions) in 57 % of the patients (30 of 53). The only complication (1.4 %) observed was one case of intraprocedural postpolypectomy bleeding, which resolved with injection of epinephrine.

CONCLUSION: In almost two-thirds of the patients examined, DBE was clinically useful for obtaining a new diagnosis and starting new treatments, changing existing treatments, carrying out surgical intervention, or providing therapeutic endoscopy. DBE is a useful and safe method of obtaining tissue for diagnosis, providing hemostasis, and carrying out polypectomy.

Article

http://www.thieme-connect.com/DOI/DOI?1 ... 005-921190

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