Title: Tu1618 A Tertiary Care Center Experience With Double-Balloon Enteroscopy
Abstract: BackgroundDouble-balloon enteroscopy (DBE) is a new technique which allows a complete small bowel examination. We report on the outcome of our experience with DBE using a Fujinon EN-450 T5 therapeutic DBE scope (Fujinon, Saitama, Japan).Material/MethodsMedical records were reviewed retrospectively of all patients who had a DBE performed between December 2007 and July 2010. During this period, 166 DBE procedures were conducted in 133 consecutive patients who were evaluated in outpatient or inpatient setting. Data collection included sex, age, procedure indications and duration, access to small bowel, and complications. All of the DBE examinations were performed by a single endoscopist.ResultsTotal 133 patients (M/F: 62/73, mean age: 59 years, range: 21-88) had DBE. The mean BMI was 26.5 kg/m2 (range: 18-42). Small bowel approach: antregrade 111, retrograde 55, and both 33. The indications for DBE included: obscure gastrointestinal bleeding (OGIB) 103, abdominal pain 19, capsule endoscopy (CE) suggestive of Crohn's disease (CD) 11, diarrhea 9, abnormal imaging study 7, retained capsule 6, familial adenomatous polyposis (FAP) 3, suspected neoplasia by CE 7, and incomplete colonoscopy with polyp by virtual colonoscopy 1. A total of 61 (45.9%) had positive findings. In patients with OGIB, abnormal small-bowel findings were seen in 42 (40.8%) including angiodysplasias 16, small ulcers 9, malignancy 7, erosions 5, narrowing 4, and polyps 1. An endoscopic intervention was carried out in 32/42 (76.2%). In suspected CD by CE, CD was confirmed in only in 1/11 (9%). In FAP or suspected malignancy, a polyp was removed by snare polypectomy in 1/11 (9%). In cases for abdominal pain, abnormal findings were found in 9/19 (47.4%) including ulcers 4, abnormal mucosa 2, CD 1, benign stricture 1, and cancer 1. Cancer was found in 2/7 (28.6%) with abnormal imaging. In cases with capsule retention, 4/6 (66.7%) had strictures, in which 3/6 (50%) the capsule was retrieved. CD was diagnosed in 3/9 (33.3%) with diarrhea. The average depth of insertion was 299 cm (range: 120-400) antregrade and 196 cm (range 100-360) retrograde. A single case (1/55) of failure to enter small bowel from retrograde approach was reported. Procedure related complications included hypoxemia in 2 patients resulting in early termination of the procedure. No cases of pancreatitis, ileus, perforation, hospitalization, or bleeding were reported.ConclusionsDBE procedure is a safe, important diagnostic and therapeutic tool for management of small-bowel lesions in select patients. DBE can be used to remove a retained capsule in patients who are poor surgical candidates and as an alternative procedure when pathology is detected beyond the reach of colonoscope. Detection rate of pathologic lesions is quite significant. We are expecting to see an increase in the DBE utilization. BackgroundDouble-balloon enteroscopy (DBE) is a new technique which allows a complete small bowel examination. We report on the outcome of our experience with DBE using a Fujinon EN-450 T5 therapeutic DBE scope (Fujinon, Saitama, Japan). Double-balloon enteroscopy (DBE) is a new technique which allows a complete small bowel examination. We report on the outcome of our experience with DBE using a Fujinon EN-450 T5 therapeutic DBE scope (Fujinon, Saitama, Japan). Material/MethodsMedical records were reviewed retrospectively of all patients who had a DBE performed between December 2007 and July 2010. During this period, 166 DBE procedures were conducted in 133 consecutive patients who were evaluated in outpatient or inpatient setting. Data collection included sex, age, procedure indications and duration, access to small bowel, and complications. All of the DBE examinations were performed by a single endoscopist. Medical records were reviewed retrospectively of all patients who had a DBE performed between December 2007 and July 2010. During this period, 166 DBE procedures were conducted in 133 consecutive patients who were evaluated in outpatient or inpatient setting. Data collection included sex, age, procedure indications and duration, access to small bowel, and complications. All of the DBE examinations were performed by a single endoscopist. ResultsTotal 133 patients (M/F: 62/73, mean age: 59 years, range: 21-88) had DBE. The mean BMI was 26.5 kg/m2 (range: 18-42). Small bowel approach: antregrade 111, retrograde 55, and both 33. The indications for DBE included: obscure gastrointestinal bleeding (OGIB) 103, abdominal pain 19, capsule endoscopy (CE) suggestive of Crohn's disease (CD) 11, diarrhea 9, abnormal imaging study 7, retained capsule 6, familial adenomatous polyposis (FAP) 3, suspected neoplasia by CE 7, and incomplete colonoscopy with polyp by virtual colonoscopy 1. A total of 61 (45.9%) had positive findings. In patients with OGIB, abnormal small-bowel findings were seen in 42 (40.8%) including angiodysplasias 16, small ulcers 9, malignancy 7, erosions 5, narrowing 4, and polyps 1. An endoscopic intervention was carried out in 32/42 (76.2%). In suspected CD by CE, CD was confirmed in only in 1/11 (9%). In FAP or suspected malignancy, a polyp was removed by snare polypectomy in 1/11 (9%). In cases for abdominal pain, abnormal findings were found in 9/19 (47.4%) including ulcers 4, abnormal mucosa 2, CD 1, benign stricture 1, and cancer 1. Cancer was found in 2/7 (28.6%) with abnormal imaging. In cases with capsule retention, 4/6 (66.7%) had strictures, in which 3/6 (50%) the capsule was retrieved. CD was diagnosed in 3/9 (33.3%) with diarrhea. The average depth of insertion was 299 cm (range: 120-400) antregrade and 196 cm (range 100-360) retrograde. A single case (1/55) of failure to enter small bowel from retrograde approach was reported. Procedure related complications included hypoxemia in 2 patients resulting in early termination of the procedure. No cases of pancreatitis, ileus, perforation, hospitalization, or bleeding were reported. Total 133 patients (M/F: 62/73, mean age: 59 years, range: 21-88) had DBE. The mean BMI was 26.5 kg/m2 (range: 18-42). Small bowel approach: antregrade 111, retrograde 55, and both 33. The indications for DBE included: obscure gastrointestinal bleeding (OGIB) 103, abdominal pain 19, capsule endoscopy (CE) suggestive of Crohn's disease (CD) 11, diarrhea 9, abnormal imaging study 7, retained capsule 6, familial adenomatous polyposis (FAP) 3, suspected neoplasia by CE 7, and incomplete colonoscopy with polyp by virtual colonoscopy 1. A total of 61 (45.9%) had positive findings. In patients with OGIB, abnormal small-bowel findings were seen in 42 (40.8%) including angiodysplasias 16, small ulcers 9, malignancy 7, erosions 5, narrowing 4, and polyps 1. An endoscopic intervention was carried out in 32/42 (76.2%). In suspected CD by CE, CD was confirmed in only in 1/11 (9%). In FAP or suspected malignancy, a polyp was removed by snare polypectomy in 1/11 (9%). In cases for abdominal pain, abnormal findings were found in 9/19 (47.4%) including ulcers 4, abnormal mucosa 2, CD 1, benign stricture 1, and cancer 1. Cancer was found in 2/7 (28.6%) with abnormal imaging. In cases with capsule retention, 4/6 (66.7%) had strictures, in which 3/6 (50%) the capsule was retrieved. CD was diagnosed in 3/9 (33.3%) with diarrhea. The average depth of insertion was 299 cm (range: 120-400) antregrade and 196 cm (range 100-360) retrograde. A single case (1/55) of failure to enter small bowel from retrograde approach was reported. Procedure related complications included hypoxemia in 2 patients resulting in early termination of the procedure. No cases of pancreatitis, ileus, perforation, hospitalization, or bleeding were reported. ConclusionsDBE procedure is a safe, important diagnostic and therapeutic tool for management of small-bowel lesions in select patients. DBE can be used to remove a retained capsule in patients who are poor surgical candidates and as an alternative procedure when pathology is detected beyond the reach of colonoscope. Detection rate of pathologic lesions is quite significant. We are expecting to see an increase in the DBE utilization. DBE procedure is a safe, important diagnostic and therapeutic tool for management of small-bowel lesions in select patients. DBE can be used to remove a retained capsule in patients who are poor surgical candidates and as an alternative procedure when pathology is detected beyond the reach of colonoscope. Detection rate of pathologic lesions is quite significant. We are expecting to see an increase in the DBE utilization.
Publication Year: 2011
Publication Date: 2011-04-01
Language: en
Type: article
Indexed In: ['crossref']
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Cited By Count: 2
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