|
1
|
Damjanovska S, Isenberg G. Endoscopic Treatment of Small Bowel Bleeding. Gastrointest Endosc Clin N Am 2024; 34:331-343. [PMID: 38395487 DOI: 10.1016/j.giec.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Approximately 5% of all gastrointestinal (GI) bleeding originates from the small bowel. Endoscopic therapy of small bowel bleeding should only be undertaken after consideration of the different options, and the risks, benefits, and alternatives of each option. Endoscopic therapy options for small bowel bleeding are like those treatments used for other forms of bleeding in the upper and lower GI tract. Available endoscopic treatment options include thermal therapy (eg, argon plasma coagulation and bipolar cautery), mechanical therapy (eg, hemoclips), and medical therapy (eg, diluted epinephrine injection). Patients with complicated comorbidities would benefit from evaluation and planning of available treatment options, including conservative and/or medical treatments, beyond endoscopic therapy.
Collapse
Affiliation(s)
- Sofi Damjanovska
- Department of Medicine, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Gerard Isenberg
- Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| |
Collapse
|
|
2
|
Li X, Zhang C, Yao L, Zhang J, Zhang K, Feng H, Yu H. A deep learning-based system to identify originating mural layer of upper gastrointestinal submucosal tumors under EUS. Endosc Ultrasound 2023; 12:465-471. [PMID: 38948124 PMCID: PMC11213599 DOI: 10.1097/eus.0000000000000029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Background and Objective EUS is the most accurate procedure to determine the originating mural layer and subsequently select the treatment of submucosal tumors (SMTs). However, it requires superb technical and cognitive skills. In this study, we propose a system named SMT Master to determine the originating mural layer of SMTs under EUS. Materials and Methods We developed 3 models: deep convolutional neural network (DCNN) 1 for lesion segmentation, DCNN2 for mural layer segmentation, and DCNN3 for the originating mural layer classification. A total of 2721 EUS images from 201 patients were used to train the 3 models. We validated our model internally and externally using 283 images from 26 patients and 172 images from 26 patients, respectively. We applied 368 images from 30 patients for the man-machine contest and used 30 video clips to test the originating mural layer classification. Results In the originating mural layer classification task, DCNN3 achieved a classification accuracy of 84.43% and 80.68% at internal and external validations, respectively. In the video test, the accuracy was 80.00%. DCNN1 achieved Dice coefficients of 0.956 and 0.776 for lesion segmentation at internal and external validations, respectively, whereas DCNN2 achieved Dice coefficients of 0.820 and 0.740 at internal and external validations, respectively. The system achieved 90.00% accuracy in classification, which is comparable with that of EUS experts. Conclusions Our proposed system has the potential to solve difficulties in determining the originating mural layer of SMTs in EUS procedures, which relieves the EUS learning pressure of physicians.
Collapse
Affiliation(s)
- Xun Li
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Chenxia Zhang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Liwen Yao
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jun Zhang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Kun Zhang
- Wuhan Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Hui Feng
- Information center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Honggang Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| |
Collapse
|
|
3
|
Polovinkin VV, Khmelik SV, Zheng L. Meckel’s diverticulum: a cause of recurrent gastrointestinal bleeding. INNOVATIVE MEDICINE OF KUBAN 2023:100-102. [DOI: 10.35401/2541-9897-2023-26-2-100-102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/03/2025]
Abstract
Background: Obscure gastrointestinal bleedings accounting for 5%-30% of all gastrointestinal bleedings continue to be a challenge and usually originate from the small bowel.Clinical case: We present a case of a female patient hospitalized with signs of gastrointestinal bleeding three times within 3 months. We could not identify the source of bleeding using standard methods, such as abdominal computed tomography and ultrasonography, esophagogastroduodenoscopy, and colonoscopy. We detected a Meckel’s diverticulum during a diagnostic laparoscopy and performed wedge resection of the small bowel. Histopathology results revealed an acute progressive ulcer in the wall of the small bowel diverticulum.Conclusions: Diagnostic laparoscopy is one of the available minimally invasive procedures, which in some cases can successfully identify the source of small bowel bleeding.
Collapse
Affiliation(s)
- V. V. Polovinkin
- Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1; Kuban State Medical University
| | - S. V. Khmelik
- Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1
| | - Liu Zheng
- Chinese Academy of Medical Sciences and Peking Union Medical College
| |
Collapse
|
|
4
|
Zhu CN, Friedland J, Yan B, Wilson A, Gregor J, Jairath V, Sey M. Presence of Melena in Obscure Gastrointestinal Bleeding Predicts Bleeding in the Proximal Small Intestine. Dig Dis Sci 2018. [PMID: 29516329 DOI: 10.1007/s10620-018-5003-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Melena is a symptom of upper gastrointestinal bleeding and usually indicates bleeding proximal to the ligament of Treitz. However, whether melena predicts bleeding in the proximal small intestine in patients with obscure gastrointestinal bleeding (OGIB) is unknown and the objective of this study. METHODS A retrospective cohort study of consecutive patients undergoing capsule endoscopy for OGIB between July 2009 and May 2016 was conducted. Subjects were categorized based on the presence of melena, and the primary outcome was identification of a bleeding source within the proximal 2/3 of the small intestine. Multi-variable regression was performed to control for confounders. RESULTS During the study, 288 patients met the eligibility criteria. Subjects with melena accounted for 37.1% of the cohort and were more likely to be older (mean age 66.9 vs. 63.9, p = 0.0457), take warfarin (15.1 vs. 9.4%, p = 0.0122), and have a lower 12-month hemoglobin nadir (7.3 vs. 8.3 g/dL, p = 0.0002). On crude analysis, 56.1% of patients with melena had a bleeding source within the proximal small intestine compared to 34.8% for those without (RR 1.61, 95% CI 1.24-2.09, p = 0.0004). On multi-variable analysis, the presence of melena doubled the odds of finding a bleeding site within the proximal small intestine (OR 1.97, 95% CI 1.17-3.33, p = 0.010). CONCLUSIONS The presence of melena doubles the odds of finding a bleeding site within the proximal small intestine among patients with OGIB, and deep enteroscopy, if performed before a capsule study, should begin with an antegrade approach in these patients.
Collapse
Affiliation(s)
- Cindy Ningfu Zhu
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Joshua Friedland
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Brian Yan
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Aze Wilson
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Jamie Gregor
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Vipul Jairath
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
- Robarts Clinical Trials, London, Canada
| | - Michael Sey
- Division of Gastroenterology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada.
- London Health Sciences Centre-Victoria Hospital, 800 Commissioners Rd. E., London, ON, N6A 5W9, Canada.
| |
Collapse
|
|
5
|
Latorre R, López-Albors O, Soria F, Morcillo E, Esteban P, Pérez-Cuadrado-Robles E, Pérez-Cuadrado-Martínez E. Evidences supporting the vascular etiology of post-double balloon enteroscopy pancreatitis: Study in porcine model. World J Gastroenterol 2017; 23:6201-6211. [PMID: 28974886 PMCID: PMC5603486 DOI: 10.3748/wjg.v23.i34.6201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/28/2017] [Accepted: 08/25/2017] [Indexed: 02/07/2023] Open
Abstract
Double balloon enteroscopy (DBE) is an endoscopic technique broadly used to diagnose and treat small bowel diseases. Among the associated complications of the oral DBE, post-procedure pancreatitis has taken the most attention due to its gravity and the thought that it might be associated to the technique itself and anatomical features of the pancreas. However, as the etiology has not been clarified yet, this paper aims to review the published literature and adds new results from a porcine animal model. Biochemical markers, histological sections and the vascular perfusion of the pancreas were monitored in the pig during DBE practice. A reduced perfusion of the pancreas and bowel, the presence of defined hypoxic areas and disseminated necrotic zones were found in the pancreatic tissue of pigs. All these evidences contribute to support a vascular distress as the most likely etiology of the post-DBE pancreatitis.
Collapse
Affiliation(s)
- Rafael Latorre
- Department of Anatomy and Comparative Pathology, University of Murcia, Campus Espinardo, 30100 Murcia, Spain
| | - Octavio López-Albors
- Department of Anatomy and Comparative Pathology, University of Murcia, Campus Espinardo, 30100 Murcia, Spain
| | - Federico Soria
- Minimally Invasive Surgery Centre Jesús Usón, 10071 Cáceres, Spain
| | - Esther Morcillo
- Minimally Invasive Surgery Centre Jesús Usón, 10071 Cáceres, Spain
| | - Pilar Esteban
- Department of Gastroenterology, Small Bowel Unit, Morales Meseguer Hospital, 30008 Murcia, Spain
| | | | | |
Collapse
|
|
6
|
Abstract
Since the introduction of double-balloon enteroscopy 15 years ago, flexible enteroscopy has become an established method in the diagnostic and therapeutic work-up of small bowel disorders. With appropriate patient selection, diagnostic and therapeutic yields of 70% to 85% can be expected. The complication rates with diagnostic and therapeutic DBE are estimated at approximately 1% and 3% to 4%, respectively. Appropriate patient selection and device selection, as well as skill, are the key issues for successful enteroscopy. However, technical developments and improvements mean that carrying out enteroscopy is likely to become easier.
Collapse
Affiliation(s)
- Andrea May
- Department of Gastroenterology, Sana Klinikum Offenbach GmbH, Starkenburgring 66, Offenbach am Main 63069, Germany.
| |
Collapse
|
|
7
|
Kopáčová M, Bureš J, Rejchrt S, Vávrová J, Bártová J, Soukup T, Tomš J, Tachecí I. Risk Factors of Acute Pancreatitis in Oral Double Balloon Enteroscopy. ACTA MEDICA (HRADEC KRÁLOVÉ) 2016; 59:84-90. [PMID: 27638962 DOI: 10.14712/18059694.2016.95] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Double balloon enteroscopy (DBE) was introduced 15 years ago. The complications of diagnostic DBE are rare, acute pancreatitis is most redoubtable one (incidence about 0.3%). Hyperamylasemia after DBE seems to be a rather common condition respectively. The most probable cause seems to be a mechanical straining of the pancreas. We tried to identify patients in a higher risk of acute pancreatitis after DBE. We investigated several laboratory markers before and after DBE (serum cathepsin B, lactoferrin, E-selectin, SPINK 1, procalcitonin, S100 proteins, alfa-1-antitrypsin, hs-CRP, malondialdehyde, serum and urine amylase and serum lipase). Serum amylase and lipase rose significantly with the maximum 4 hours after DBE. Serum cathepsin and procalcitonin decreased significantly 4 hours after DBE compared to healthy controls and patients values before DBE. Either serum amylase or lipase 4 hours after DBE did not correlate with any markers before DBE. There was a trend for an association between the number of push-and-pull cycles and procalcitonin and urine amylase 4 hours after DBE; between procalcitonin and alfa-1-antitrypsin, cathepsin and hs-CRP; and between E-selectin and malondialdehyde 4 hours after DBE. We found no laboratory markers determinative in advance those patients in a higher risk of acute pancreatitis after DBE.
Collapse
Affiliation(s)
- Marcela Kopáčová
- 2nd Department of Medicine - Gastroenterology, Charles University, Faculty of Medicine in Hradec Králové, University Teaching Hospital, Hradec Králové, Czech Republic.
| | - Jan Bureš
- 2nd Department of Medicine - Gastroenterology, Charles University, Faculty of Medicine in Hradec Králové, University Teaching Hospital, Hradec Králové, Czech Republic
| | - Stanislav Rejchrt
- 2nd Department of Medicine - Gastroenterology, Charles University, Faculty of Medicine in Hradec Králové, University Teaching Hospital, Hradec Králové, Czech Republic
| | - Jaroslava Vávrová
- Institute of Clinical Biochemistry and Diagnostics, Charles University, Faculty of Medicine in Hradec Králové, University Teaching Hospital, Hradec Králové, Czech Republic
| | - Jolana Bártová
- 2nd Department of Medicine - Gastroenterology, Charles University, Faculty of Medicine in Hradec Králové, University Teaching Hospital, Hradec Králové, Czech Republic
| | - Tomáš Soukup
- 2nd Department of Medicine - Gastroenterology, Charles University, Faculty of Medicine in Hradec Králové, University Teaching Hospital, Hradec Králové, Czech Republic
| | - Jan Tomš
- 2nd Department of Medicine - Gastroenterology, Charles University, Faculty of Medicine in Hradec Králové, University Teaching Hospital, Hradec Králové, Czech Republic
| | - Ilja Tachecí
- 2nd Department of Medicine - Gastroenterology, Charles University, Faculty of Medicine in Hradec Králové, University Teaching Hospital, Hradec Králové, Czech Republic
| |
Collapse
|
|
8
|
Shiani A, Nieves J, Lipka S, Patel B, Kumar A, Brady P. Degree of concordance between single balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding after an initial positive capsule endoscopy finding. Therap Adv Gastroenterol 2016; 9:13-8. [PMID: 26770263 PMCID: PMC4699275 DOI: 10.1177/1756283x15610042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION In patients with obscure gastrointestinal bleeding (OBGIB) capsule endoscopy (CE) is the initial diagnostic procedure of choice. Often patients undergo single balloon enteroscopy (SBE) with both diagnostic and therapeutic intention after CE. Although SBE offers a therapeutic benefit, long procedure times, complexity, and invasiveness are drawbacks. We aimed to evaluate the diagnostic correlation between these two modalities after an initial positive CE finding. METHODS We performed a retrospective review of 418 patients who underwent CE at our institution from January 2010 to May 2014. A total of 95 patients were analyzed after selecting patients that underwent SBE originally after a positive CE result for the evaluation for OGIB. Agreement beyond chance was evaluated using the κ coefficient. A p value less than 5% was considered statistically significant. RESULTS The mean age of our population was 65.8 ± 12.2 and it was female predominant: 57/95 (60%). The most frequent positive findings were vascular lesions found on SBE in 31.6% and on CE in 41.1%. There was a strong agreement when identifying active bleeding and clots [κ=0.97; 95% confidence interval (CI) 0.92-1.03; p ⩽ 0.0001], and a moderate agreement when diagnosing vascular lesions (0.41; 95% CI 0.21-0.61; p ⩽ 0.0001). There was fair agreement for ulcers (0.26; 95% CI 0.07-0.59; p = 0.005). There was a low correlation between masses, polyps, and others. CONCLUSION CE still remains the initial test of choice in evaluating stable patients with OBGIB since it has strong-to-fair concordance for the major small bowel findings. However, in cases of severe overt small bowel bleeding, balloon-assisted enteroscopy can be considered the initial procedure of choice since it is therapeutic as well as diagnostic and this approach avoids delays in treatment. Further research should focus on methods to improve interpretation of CE and enhance the ability to evaluate the entire small bowel with SBE.
Collapse
Affiliation(s)
- Ashok Shiani
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Javier Nieves
- Department of Internal Medicine, Division of Digestive Diseases and Nutrition, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | | | - Brijesh Patel
- Department of Internal Medicine, Division of Digestive Diseases and Nutrition, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Ambuj Kumar
- Department of Evidence Based Medicine and Outcomes Research, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Patrick Brady
- Department of Internal Medicine, Division of Digestive Diseases and Nutrition, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| |
Collapse
|
|
9
|
Chauhan SS, Manfredi MA, Abu Dayyeh BK, Enestvedt BK, Fujii-Lau LL, Komanduri S, Konda V, Maple JT, Murad FM, Pannala R, Thosani NC, Banerjee S. Enteroscopy. Gastrointest Endosc 2015; 82:975-90. [PMID: 26388546 DOI: 10.1016/j.gie.2015.06.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 06/11/2015] [Indexed: 12/14/2022]
Abstract
Noninvasive imaging with CT and magnetic resonance enterography or direct visualization with wireless capsule endoscopy can provide valuable diagnostic information and direct therapy. Enteroscopy technology and techniques have evolved significantly and allow diagnosis and therapy deep within the small bowel, previously attainable only with intraoperative enteroscopy. Push enteroscopy, readily available in most endoscopy units, plays an important role in the evaluation and management of lesions located up to the proximal jejunum. Currently available device-assisted enteroscopy systems, DBE, SBE, and spiral enteroscopy each have their technical nuances, clinical advantages, and limitations. Newer, on-demand enteroscopy systems appear promising, but further studies are needed. Despite slight differences in parameters such as procedural times, depths of insertion, and rates of complete enteroscopy, the overall clinical outcomes with all overtube-assisted systems appear to be similar. Endoscopists should therefore master the enteroscopy technology based on institutional availability and their level of technical expertise.
Collapse
|
|
10
|
ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding. Am J Gastroenterol 2015; 110:1265-87; quiz 1288. [PMID: 26303132 DOI: 10.1038/ajg.2015.246] [Citation(s) in RCA: 435] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 06/01/2015] [Indexed: 02/06/2023]
Abstract
Bleeding from the small intestine remains a relatively uncommon event, accounting for ~5-10% of all patients presenting with gastrointestinal (GI) bleeding. Given advances in small bowel imaging with video capsule endoscopy (VCE), deep enteroscopy, and radiographic imaging, the cause of bleeding in the small bowel can now be identified in most patients. The term small bowel bleeding is therefore proposed as a replacement for the previous classification of obscure GI bleeding (OGIB). We recommend that the term OGIB should be reserved for patients in whom a source of bleeding cannot be identified anywhere in the GI tract. A source of small bowel bleeding should be considered in patients with GI bleeding after performance of a normal upper and lower endoscopic examination. Second-look examinations using upper endoscopy, push enteroscopy, and/or colonoscopy can be performed if indicated before small bowel evaluation. VCE should be considered a first-line procedure for small bowel investigation. Any method of deep enteroscopy can be used when endoscopic evaluation and therapy are required. VCE should be performed before deep enteroscopy if there is no contraindication. Computed tomographic enterography should be performed in patients with suspected obstruction before VCE or after negative VCE examinations. When there is acute overt hemorrhage in the unstable patient, angiography should be performed emergently. In patients with occult hemorrhage or stable patients with active overt bleeding, multiphasic computed tomography should be performed after VCE or CTE to identify the source of bleeding and to guide further management. If a source of bleeding is identified in the small bowel that is associated with significant ongoing anemia and/or active bleeding, the patient should be managed with endoscopic therapy. Conservative management is recommended for patients without a source found after small bowel investigation, whereas repeat diagnostic investigations are recommended for patients with initial negative small bowel evaluations and ongoing overt or occult bleeding.
Collapse
|
|
11
|
Predictability of capsule endoscopy referred to a tertiary care center for double-balloon enteroscopy. Eur J Gastroenterol Hepatol 2015; 27:1052-6. [PMID: 26049708 DOI: 10.1097/meg.0000000000000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Patients with obscure gastrointestinal bleeding with 'positive' findings on video capsule endoscopy (VCE) by gastroenterologists practicing in the community are often referred to tertiary care centers for double-balloon enteroscopy (DBE). Our study explores the degree of concordance between these two procedures performed in two different clinical settings. METHODS Concordance between the procedures was estimated using a κ-coefficient. RESULTS A total of 73 patients with obscure gastrointestinal bleeding were referred to our center for DBE after undergoing VCE elsewhere. Ten of these patients (10/73 or 13.7%) had been found to have bleeding in the small bowel on VCE without any concrete diagnosis. DBE revealed the source of bleeding in 17 of the 22 patients (77.3%) with normal VCE. The referral diagnosis was correct in 31 cases (31/73 or 42.5%). The κ-coefficient for VCE and DBE for the 63 patients was 0.28, suggesting poor agreement between the two procedures. However, most patients with a referral diagnosis of vascular pathology were confirmed to have vascular disease on DBE (19/23 or 82.6%). CONCLUSION Our study shows that there is a poor concordance between capsule endoscopy performed in the community and confirmatory DBE performed at our tertiary care center.
Collapse
|
|
12
|
Nishizawa T, Suzuki H, Fujimoto A, Ochiai Y, Kanai T, Naohisa Y. Effects of carbon dioxide insufflation in balloon-assisted enteroscopy: A systematic review and meta-analysis. United European Gastroenterol J 2015; 4:11-7. [PMID: 26966518 DOI: 10.1177/2050640615588024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 04/29/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND AIM The efficacy of CO2 insufflation during balloon-assisted enteroscopy remains controversial. This study aimed to perform a systematic review with meta-analysis of randomized controlled trials (RCTs) in which CO2 insufflation was compared with air insufflation in balloon-assisted enteroscopy. METHODS PubMed, the Cochrane library, and the Igaku-Chuo-Zasshi database were searched to identify RCTs eligible for inclusion in the systematic review. Data from the eligible studies were combined to calculate the pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs). RESULTS Four RCTs (461 patients) were identified. Compared with air insufflation, CO2 insufflation significantly increased intubation depth of oral enteroscopy (WMD: 55.2, 95% CI: 10.77-99.65, p = 0.015). However, there was significant heterogeneity. The intubation depth of anal enteroscopy showed no significant difference between the CO2 group and the air group. CO2 insufflation significantly reduced abdominal pain compared with air insufflation (WMD: -2.463, 95% CI: -4.452 to -0.474, p = 0.015), without significant heterogeneity. The PaCO2 or end-tidal CO2 level showed no significant difference between the CO2 group and air group. CONCLUSIONS Compared with air insufflation, CO2 insufflation during balloon-assisted enteroscopy caused less post-procedural pain without CO2 retention.
Collapse
Affiliation(s)
- Toshihiro Nishizawa
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hidekazu Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ai Fujimoto
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Yasutoshi Ochiai
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yahagi Naohisa
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
|
13
|
Yamamoto H, Yano T, Ohmiya N, Tanaka S, Tanaka S, Endo Y, Matsuda T, Matsui T, Iida M, Sugano K. Double-balloon endoscopy is safe and effective for the diagnosis and treatment of small-bowel disorders: prospective multicenter study carried out by expert and non-expert endoscopists in Japan. Dig Endosc 2015; 27:331-337. [PMID: 25180488 DOI: 10.1111/den.12378] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 08/25/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Double-balloon endoscopy (DBE) has enabled direct, detailed examination of the entire small bowel with interventional capabilities. Although its usefulness is recognized, efficacy and safety have not been extensively evaluated by prospective multicenter studies. To evaluate the efficacy and safety of DBE carried out by expert and non-expert endoscopists, a prospective, multicenter study was conducted in five university hospitals and a general hospital in Japan. METHODS A total of 120 patients who underwent 179 procedures were enrolled in the study. Experts carried out 129 procedures and non-experts carried out 50 procedures. Primary and secondary end points were evaluation of safety, the rate of achievement of procedural objectives, namely, identification of a new lesion, detailed examination to establish a therapeutic strategy, or exclusion of significant lesions by total enteroscopy, and rate of successful examination of the entire small bowel and evaluation of safety. RESULTS Overall rate of achievement of procedural objectives was 82.5% (99/120). Overall success rate for examination of the entire small bowel was 70.8% (34/48). Incidence of adverse events was 1.1% (a mucosal injury and an episode of pyrexia in two of 179 examinations). No severe adverse events were encountered. There were no significant differences in any of the outcome measures comparing expert and non-expert operators. CONCLUSIONS DBE is effective and safe for patients with suspected small bowel diseases, and can be safely carried out even by a non-expert under the supervision of an expert, following a simple training program.
Collapse
Affiliation(s)
- Hironori Yamamoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
14
|
Abstract
PURPOSE OF REVIEW This review summarizes the recent developments in the evaluation of small bowel disorders using videocapsule endoscopy (VCE) and serological and breath-test biomarkers. RECENT FINDINGS The ability to visualize the small bowel was revolutionized with the introduction of VCE technology. VCE allows for accurate, noninvasive visualization of the small bowel mucosa. This device is invaluable in the investigation of obscure gastrointestinal bleeding (OGIB), occult bleeding with iron deficiency anaemia, small bowel Crohn's disease (CD), small bowel neoplasms and other mucosal disorders. Recent studies underscored the utility of VCE for documenting the extent and severity of small bowel CD as well as monitoring activity after therapy. The accuracy of the discrimination between small bowel tumours and benign bulges has been improved by a novel endoscopic algorithm. The accuracy of VCE was also evaluated as a potential noninvasive alternative to small bowel biopsies in suspected celiac disease. New findings have been made using breath tests and other biomarkers for the diagnosis of celiac disease, irritable bowel syndrome and bacterial overgrowth. SUMMARY VCE as well as breath-test biomarkers play a major and expanding role in the diagnosis and monitoring of various small bowel disorders.
Collapse
|
|
15
|
Wadhwa V, Sethi S, Tewani S, Garg SK, Pleskow DK, Chuttani R, Berzin TM, Sethi N, Sawhney MS. A meta-analysis on efficacy and safety: single-balloon vs. double-balloon enteroscopy. Gastroenterol Rep (Oxf) 2015; 3:148-55. [PMID: 25698560 PMCID: PMC4423464 DOI: 10.1093/gastro/gov003] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 01/07/2015] [Indexed: 12/20/2022] Open
Abstract
Background and aim: Double-balloon enteroscopy (DBE) and single-balloon enteroscopy (SBE) are new techniques capable of providing deep enteroscopy. Results of individual studies comparing these techniques have not been able to identify a superior strategy. Our aim was to systematically pool all available studies to compare the efficacy and safety of DBE with SBE for evaluation of the small bowel. Methods: Databases were searched, including PubMed, Embase, and the Cochrane Central Register of Controlled Trials. The main outcome measures were complete small-bowel visualization, diagnostic yield, therapeutic yield, and complication rate. Statistical analysis was performed using Review Manager (RevMan version 5.2). Meta-analysis was performed using fixed-effect or random-effect methods, depending on the absence or presence of significant heterogeneity. We used the χ2 and I2 test to assess heterogeneity between trials. Results were expressed as risk ratios (RR) or mean differences with 95% confidence intervals (CI). Results: Four prospective, randomized, controlled trials with a total of 375 patients were identified. DBE was superior to SBE for visualization of the entire small bowel [pooled RR = 0.37 (95% CI: 0.19–0.73; P = 0.004)]. DBE and SBE were similar in ability to provide diagnosis [pooled RR = 0.95 (95% CI: 0.77–1.17; P = 0.62)]. There was no significant difference between DBE and SBE in therapeutic yield [pooled RR = 0.78 (95% CI: 0.59–1.04; P = 0.09)] and complication rate [pooled RR = 1.08 (95% CI: 0.28–4.22); P = 0.91]. Conclusions: DBE was superior to SBE with regard to complete small bowel visualization. DBE was similar to SBE with regard to diagnostic yield, ability to provide treatment and complication rate, but these results should be interpreted with caution as they is based on very few studies and the overall quality of the evidence was rated as low to moderate, due to the small sample size.
Collapse
Affiliation(s)
- Vaibhav Wadhwa
- Department of Internal Medicine, Fairview Hospital, Cleveland Clinic, Cleveland, OH, USA, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA and Division of Basic and Translational Research, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Saurabh Sethi
- Department of Internal Medicine, Fairview Hospital, Cleveland Clinic, Cleveland, OH, USA, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA and Division of Basic and Translational Research, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Sumeet Tewani
- Department of Internal Medicine, Fairview Hospital, Cleveland Clinic, Cleveland, OH, USA, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA and Division of Basic and Translational Research, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Sushil Kumar Garg
- Department of Internal Medicine, Fairview Hospital, Cleveland Clinic, Cleveland, OH, USA, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA and Division of Basic and Translational Research, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Douglas K Pleskow
- Department of Internal Medicine, Fairview Hospital, Cleveland Clinic, Cleveland, OH, USA, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA and Division of Basic and Translational Research, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Ram Chuttani
- Department of Internal Medicine, Fairview Hospital, Cleveland Clinic, Cleveland, OH, USA, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA and Division of Basic and Translational Research, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Tyler M Berzin
- Department of Internal Medicine, Fairview Hospital, Cleveland Clinic, Cleveland, OH, USA, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA and Division of Basic and Translational Research, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Nidhi Sethi
- Department of Internal Medicine, Fairview Hospital, Cleveland Clinic, Cleveland, OH, USA, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA and Division of Basic and Translational Research, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Mandeep S Sawhney
- Department of Internal Medicine, Fairview Hospital, Cleveland Clinic, Cleveland, OH, USA, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA and Division of Basic and Translational Research, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
|
16
|
Raines D, Arbour A, Thompson HW, Figueroa-Bodine J, Joseph S. Variation in small bowel length: factor in achieving total enteroscopy? Dig Endosc 2015; 27:67-72. [PMID: 24861190 DOI: 10.1111/den.12309] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/08/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM Estimation of small bowel length is of interest following the recent development of device-assisted enteroscopy. This new technology allows access to the deep small bowel, but rates of examination of the entire small bowel (total enteroscopy) differ between study populations. Variation in small bowel length could factor into this observed irregularity in total enteroscopy rates. Medical literature contains limited information regarding small bowel length in living patients and conflicting data regarding small bowel length and its relationship to height and weight. We carried out small bowel measurements on surgical patients to further define the total length of the small bowel and its relationship to height, weight and body mass index (BMI). METHODS Measurement of ileojejunal length on 91 surgical patients undergoing laparotomy for routine indications. Demographic data were collected for each subject, including height, weight and BMI. RESULTS Small bowel length was found to vary widely between individuals (average 998.52 cm, range 630-1510 cm). Linear regression analysis demonstrated a statistically significant relationship between small bowel length and height (regression coefficient = 0.0561, P-value = 0.0238). A linear relationship between small bowel length and weight or BMI was not observed. CONCLUSIONS Length of the small bowel in humans is pertinent to advances in deep enteroscopy and existing surgical applications such as intestinal bypass and prevention of short gut syndrome. If average small bowel length varies with height, total enteroscopy may be easier to achieve in patients who are short in stature.
Collapse
Affiliation(s)
- Daniel Raines
- Department of Medicine, Section of Gastroenterology, LSUHSC, New Orleans, USA
| | | | | | | | | |
Collapse
|
|
17
|
Han S, Bhattacharya K, Cave DR. Preliminary colonoscopy facilitates retrograde double-balloon enteroscopy. Endosc Int Open 2014; 2:E241-3. [PMID: 26135100 PMCID: PMC4423272 DOI: 10.1055/s-0034-1377760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 07/07/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Retrograde double-balloon enteroscopy (RDBE) has a high failure rate due to difficulty intubating the ileo-cecal (IC) valve. We examined the utility of a pre-RDBE colonoscopy using a pediatric colonoscope to clean the cecum and perform an initial intubation of the IC valve. PATIENTS AND METHODS This study is a retrospective review of RDBE procedures for 45 patients at a single tertiary-care center to examine the success of IC intubation, maximal depth of enteroscope insertion, and duration of the procedure. RESULTS The IC intubation success rate among patients who underwent RDBE using this novel method was 100 % as compared to 72.7 % using the traditional method (P < 0.003). CONCLUSIONS RDBE preceded by colonoscopy had a significantly higher IC intubation success rate, compared to RDBEs performed using the traditional method. RESULTS support the use of this novel method when IC valve intubation using standard methods is difficult, and it may limit the need for repeat procedures or the use of other modalities for examining the small bowel.
Collapse
Affiliation(s)
- Samuel Han
- Department of Internal Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655 USA,Corresponding author Samuel Han, MD UMass Memorial Medical Center55 Lake Avenue NorthWorcester, Massachusetts 01655 USA+01-508-856-3981
| | - Kanishka Bhattacharya
- Department of Internal Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655 USA
| | - David R Cave
- Department of Internal Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655 USA
| |
Collapse
|
|
18
|
Wang SJ, Mao GP, Tang J, Ning SB, Jin XW, Zhu M. Double-balloon endoscopy for diagnosis of small intestinal disorders: A systematic review of data over the first decade of use. Shijie Huaren Xiaohua Zazhi 2014; 22:1616-1621. [DOI: 10.11569/wcjd.v22.i11.1616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To systematically analyze data on diagnostic rate, observation scope, and complications of double-balloon endoscopy (DBE) for small bowel diseases, and to further evaluate its clinical value and security.
METHODS: A total of 1036 patients (585 men and 451 women) with suspected or known small-bowel diseases underwent 1202 DBE procedures (oral 589, anal 613, both approaches 184) under anesthesia with propofol at our institution over the past decade.
RESULTS: The success rate of DBE was 99.2% (1193/1202), and the positive diagnostic yield was 84.5% (875/1036). The main diagnosis was polyps and tumors (391/1202; 32.5%), erosions and ulcerations (246/1202; 20.4%), and angiodysplasia (52/1202; 4.32%). The mean duration of the procedure was 78 min ± 43 min (30-180 min). On average, 231 cm ± 74 cm of the small bowel was visualized by using the oral route and 176 cm ± 69 cm by using the anal route (P < 0.05). Most common lesions detected in patients with OGIB (obscure gastrointestinal bleeding) were ulcers and erosions (57/218; 26.1%), vascular diseases (33/218; 15.1%), and tumors and polyps (28/218; 12.8%). Among 63 small bowel tumor cases, 45 were malignant (45/63; 71%) and 18 were benign (18/63; 29%). Histopathology was consistent with the endoscopic diagnosis in 87.5% (63/72) of patients with small bowel tumors. Severe complications were observed in 11/1202 (0.915%) of cases. A minority of patients complained of mild sore throat, anal pain or abdominal distension after the DBE procdure.
CONCLUSION: Our retrospective analysis shows that DBE is a safe and effective method to diagnose small bowel disorders by visualization and tissue sampling to assist in diagnosis of etiology.
Collapse
|
|
19
|
Sami SS, Al-Araji SA, Ragunath K. Review article: gastrointestinal angiodysplasia - pathogenesis, diagnosis and management. Aliment Pharmacol Ther 2014; 39:15-34. [PMID: 24138285 DOI: 10.1111/apt.12527] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 08/14/2013] [Accepted: 09/18/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Angiodysplasia (AD) of the gastrointestinal (GI) tract is an important condition that can cause significant morbidity and -rarely - mortality. AIM To provide an up-to-date comprehensive summary of the literature evaluating this disease entity with a particular focus on pathogenesis as well as current and emerging diagnostic and therapeutic modalities. Recommendations for treatment will be made on the basis of the current available evidence and consensus opinion of the authors. METHODS A systematic literature search was performed. The search strategy used the keywords 'angiodysplasia' or 'arteriovenous malformation' or 'angioectasia' or 'vascular ectasia' or 'vascular lesions' or 'vascular abnormalities' or 'vascular malformations' in the title or abstract. RESULTS Most AD lesions (54-81.9%) are detected in the caecum and ascending colon. They may develop secondary to chronic low-grade intermittent obstruction of submucosal veins coupled with increased vascular endothelial growth factor-dependent proliferation. Endotherapy with argon plasma coagulation resolves bleeding in 85% of patients with colonic AD. In patients who fail (or are not suitable for) other interventions, treatment with thalidomide or octreotide can lead to a clinically meaningful response in 71.4% and 77% of patients respectively. CONCLUSIONS Angiodysplasia is a rare, but important, cause of both overt and occult GI bleeding especially in the older patients. Advances in endoscopic imaging and therapeutic techniques have led to improved outcomes in these patients. The choice of treatment should be decided on a patient-by-patient basis. Further research is required to better understand the pathogenesis and identify potential therapeutic targets.
Collapse
Affiliation(s)
- S S Sami
- Nottingham Digestive Diseases Centre & NIHR Biomedical research Unit, Queens Medical Centre, Nottingham, UK
| | | | | |
Collapse
|
|
20
|
Tian Min C, Li Hua X, Ying Lin J, Yan Mei Y, Fei L, Jun Bo Q. The role of double-balloon enteroscopy following capsule endoscopy in diagnosis of obscure Small intestinal diseases. Pak J Med Sci 2013; 29:479-84. [PMID: 24353560 PMCID: PMC3809242 DOI: 10.12669/pjms.292.2927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 01/09/2013] [Indexed: 12/22/2022] Open
Abstract
Objective: The aim of this study was to evaluate the detection rate accuracy of Double-balloon Enteroscopy (DBE) after Capsule Endoscopy (CE) in patients with suspected small bowel diseases. Methodology: From January 2009 to March 2012, sixty-two patients with obscure small bowel diseases who underwent CE followed by DBE were included in this study. Introduction of the endoscope by DBE was either orally or anally according to CE. Results: Sixty-two patients are reported. The overall detection rate of small bowel diseases using CE was 70.9% (44/62). Sixty-eight DBE procedures following capsule endoscopy were carried out, There was no significant difference (χ2=0.6739, P>0.05) of Positive findings between CE and CE +DBE. Furthermore, the detection rate of small bowel diseases in patients with obscure small intestinal bleeding using CE +DBE (90.9%, 30/33) was superior to that of CE (78.8%, 26/33); χ2=1.8857, P>0.05. Conclusions: Capsule Endoscopy (CE) can cover the whole GI tract and provide the selection of the route of Double-balloon enteroscopy (DBE). DBE can also serve as a good complementary approach after an initial imaging using CE. It can verify the findings of CE and provide therapeutic intervention. Using of CE followed by DBE is effective in the diagnosis and management of patients with obscure small bowel diseases.
Collapse
Affiliation(s)
- Chen Tian Min
- Chen Tian Min, Department of Gastroenterology, The first people's Hospital of Nantong, Jiangsu, China 226001
| | - Xu Li Hua
- Xu Li Hua, Department of Gastroenterology, The first people's Hospital of Nantong, Jiangsu, China 226001
| | - Ji Ying Lin
- Ji Ying Lin, Department of Gastroenterology, The first people's Hospital of Nantong, Jiangsu, China 226001
| | - Yang Yan Mei
- Yang Yan Mei, Department of Gastroenterology, The first people's Hospital of Nantong, Jiangsu, China 226001
| | - Lu Fei
- Lu Fei, Department of Gastroenterology, The first people's Hospital of Nantong, Jiangsu, China 226001
| | - Qian Jun Bo
- Qian Jun Bo, Department of Gastroenterology, The first people's Hospital of Nantong, Jiangsu, China 226001
| |
Collapse
|
|
21
|
Lenz P, Roggel M, Domagk D. Double- vs. single-balloon enteroscopy: single center experience with emphasis on procedural performance. Int J Colorectal Dis 2013; 28:1239-46. [PMID: 23503664 DOI: 10.1007/s00384-013-1673-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aims to compare double- (DBE) and single-balloon enteroscopy (SBE) in small bowel disorders with respect to procedural performance and clinical impact. METHODS This retrospective analysis at a tertial referral center included 1,052 DBEs and 515 SBEs performed in 904 patients over 7 years. Procedural and patients' characteristics were precisely analyzed. RESULTS Significantly more patients with anemia and gastrointestinal bleeding were investigated by DBE (P < 0.01). Oral insertion depth and length of investigated small bowel in the combined approach were significantly higher in the DBE compared to the SBE group (245 ± 65.3 vs. 218 ± 62.6 and 355 ± 101.9 vs. 319 ± 91.2, respectively; P < 0.001, each). By analyzing only recent years of enteroscopy (2008-2011), no difference in small bowel visualization could be observed. The anal insertion depths and complete enteroscopy rates (CER) were comparable. Procedure times were significantly shorter within the SBE procedure (oral: 50 vs. 40 min; anal: 55 vs. 46 min, P < 0.001) and the usage of sedation was significantly less (propofol: P < 0.001; pethidine: P < 0.05). Diagnostic yield was significantly higher in the SBE, compared to the DBE group (61.7 vs. 48.2 %; P < 0.001). The rate of severe adverse events was close to zero. CONCLUSION Both enteroscopy techniques are safe diagnostic tools and proved to be indispensable in the daily gastroenterological practice. The lower insertion depths, but higher diagnostic yield, of SBE may reflect the more focused selection of patients scheduled for small bowel diagnostics in recent years.
Collapse
Affiliation(s)
- Philipp Lenz
- Department of Medicine B, University of Muenster, Albert-Schweitzer-Campus 1, Building A1, Muenster, Germany.
| | | | | |
Collapse
|
|
22
|
Abstract
Video capsule endoscopy has revolutionized our ability to visualize the entire small bowel mucosa. This modality is established as a valuable tool for the diagnosis of obscure gastrointestinal bleeding, Crohn's disease, small bowel tumors, and other conditions involving the small bowel mucosa. This review includes an overview of the current and potential future clinical applications of small bowel video endoscopy.
Collapse
Affiliation(s)
- Uri Kopylov
- Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada
| | | |
Collapse
|
|
23
|
Abstract
Video capsule endoscopy has revolutionized our ability to visualize the entire small bowel mucosa. This modality is established as a valuable tool for the diagnosis of obscure gastrointestinal bleeding, Crohn’s disease, small bowel tumors, and other conditions involving the small bowel mucosa. This review includes an overview of the current and potential future clinical applications of small bowel video endoscopy.
Collapse
Affiliation(s)
- Uri Kopylov
- Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada
| | | |
Collapse
|
|
24
|
Rahmi G, Samaha E, Vahedi K, Ponchon T, Fumex F, Filoche B, Gay G, Delvaux M, Lorenceau-Savale C, Malamut G, Canard JM, Chatellier G, Cellier C. Multicenter comparison of double-balloon enteroscopy and spiral enteroscopy. J Gastroenterol Hepatol 2013; 28:992-8. [PMID: 23488827 DOI: 10.1111/jgh.12188] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Spiral enteroscopy is a novel technique for small bowel exploration. The aim of this study is to compare double-balloon and spiral enteroscopy in patients with suspected small bowel lesions. METHODS Patients with suspected small bowel lesion diagnosed by capsule endoscopy were prospectively included between September 2009 and December 2010 in five tertiary-care academic medical centers. RESULTS After capsule endoscopy, 191 double-balloon enteroscopy and 50 spiral enteroscopies were performed. Indications were obscure gastrointestinal bleeding in 194 (80%) of cases. Lesions detected by capsule endoscopy were mainly angioectasia. Double-balloon and spiral enteroscopy resulted in finding one or more lesions in 70% and 75% of cases, respectively. The mean diagnosis procedure time and the average small bowel explored length during double-balloon and spiral enteroscopy were, respectively, 60 min (45-80) and 55 min (45-80) (P=0.74), and 200 cm (150-300) and 220 cm (200-300) (P=0.13). Treatment during double-balloon and spiral enteroscopy was possible in 66% and 70% of cases, respectively. There was no significant major procedure-related complication. CONCLUSION Spiral enteroscopy appears as safe as double-balloon enteroscopy for small bowel exploration with a similar diagnostic and therapeutic yield. Comparison between the two procedures in terms of duration and length of small bowel explored is slightly in favor of spiral enteroscopy but not significantly.
Collapse
Affiliation(s)
- Gabriel Rahmi
- Department of Gastroenterology and Endoscopy, Rene Descartes University, France.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
25
|
Rahmi G, Samaha E, Lorenceau-Savale C, Landi B, Edery J, Manière T, Canard JM, Malamut G, Chatellier G, Cellier C. Small bowel polypectomy by double balloon enteroscopy: Correlation with prior capsule endoscopy. World J Gastrointest Endosc 2013; 5:219-25. [PMID: 23678374 PMCID: PMC3653020 DOI: 10.4253/wjge.v5.i5.219] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 07/13/2012] [Accepted: 03/15/2013] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate the feasibility of small bowel polypectomy using double balloon enteroscopy and to evaluate the correlation with capsule endoscopy (CE).
METHODS: This is a retrospective review of a single tertiary hospital. Twenty-five patients treated by enteroscopy for small bowel polyps diagnosed by CE or other imaging techniques were included. The correlation between CE and enteroscopy (correlation coefficient of Kendall for the number of polyps, intra-class coefficient for the size and coefficient of correlation kappa for the location) was evaluated.
RESULTS: There were 31 polypectomies and 12 endoscopic mucosal resections with limited morbidity and no mortality. Histological analysis revealed 27 hamartomas, 6 adenomas and 3 lipomas. Strong agreement between CE and optical enteroscopy was observed for both location (Kappa value: 0.90) and polyp size (Kappa value: 0.76), but only moderate agreement was found for the number of polyps (Kendall value: 0.47).
CONCLUSION: Double balloon enteroscopy is safe for performing polypectomy. Previous CE is useful in selecting the endoscopic approach and to predicting the difficulty of the procedure.
Collapse
Affiliation(s)
- Gabriel Rahmi
- Gabriel Rahmi, Elia Samaha, Camille Lorenceau-Savale, Bruno Landi, Joël Edery, Thibault Manière, Jean-Marc Canard, Georgia Malamut, Christophe Cellier, Department of Gastroenterology and Endoscopy, University Rene-Descartes, Georges Pompidou European Hospital, 75015 Paris, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
26
|
Patel NC, Palmer WC, Gill KR, Cangemi D, Diehl N, Stark ME. Changes in efficiency and resource utilization after increasing experience with double balloon enteroscopy. World J Gastrointest Endosc 2013; 5:89-94. [PMID: 23515876 PMCID: PMC3600554 DOI: 10.4253/wjge.v5.i3.89] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 01/15/2013] [Accepted: 02/05/2013] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate changes in efficiency and resource utilization as a single endoscopist’s experience increased with each subsequent 100 double balloon enteroscopy (DBE) procedures.
METHODS: We reviewed consecutive DBE procedures performed by a single endoscopist at our center over 4 years. DBE was employed when the clinician deemed the procedure was needed for disease management. The approach (oral, anal or both) was chosen based on suspected location of the target lesion. All DBE was performed in a standard endoscopy room with a portable fluoroscopy unit. Fluoroscopy was used to aid in shortening the small intestine and reducing bowel loops. For oral DBE, measurements were taken from the incisors. For anal DBE, measurements were taken from the anal verge. Enteroscopy continued until the target lesion was reached, until the entire small intestine was examined, or until no further progress was deemed possible. The length of small intestine examined (cm), procedure duration (min), and fluoroscopy time (s) were analyzed for sequential groups of 100 DBE. Sub-groups of diagnostic and therapeutic procedures were analyzed using multivariable linear regression.
RESULTS: 802 consecutive DBE procedures were analyzed. For oral DBE, median [interquartile range (IQR)] length of small bowel examined was 230.8 cm (range: 210-248 cm) and for anal DBE was 143.5 cm (range: 100-180 cm). No significant increase in length examined was noted for either the oral or anal approach with advancing position in series. In terms of duration of procedure, the median (IQR) for oral DBE was 86 min (range: 71-105 min) and for anal DBE was 81.3 min (range: 67-105 min). When comparing by the position in series, there was a significant (P value < 0.001) decrease in procedure duration for both upper and lower procedures with increasing experience. Median (IQR) time of exposure to fluoroscopy for oral DBE was 190 s (114-275) compared to anal DBE which was 196.4 s (312-128). This represented a significant (P value < 0.001) decrease in the amount of fluoroscopy used with increasing position in series. For both oral and anal DBE, fluoroscopy time was reduced by greater than 50% over the course of 802 total procedures performed. Sub-group analysis was conducted on therapeutic and diagnostic groups. Out of 802 procedures, a total of 434 were considered therapeutic. Argon plasma coagulation was by far the most common therapeutic intervention performed. There was no evidence of a difference in length examined or fluoroscopy exposure among oral DBE for diagnostic and therapeutic procedures, P = 0.91 and P = 0.32 respectively. The median (IQR) for length was 235 cm (range: 178-280 cm) for diagnostic vs 230 cm (range: 180-275 cm) for therapeutic procedures; additionally, fluoroscopy time median (IQR) was 180 s (range: 110-295 s) and 162 s (range: 102-263 s) for no intervention and intervention. However, there was a significant difference in procedure duration among oral DBE (P < 0.001). The median (IQR) was 80 min (range: 60-97 min) and 94 min (range: 77-110 min) for diagnostic and therapeutic interventions respectively.
CONCLUSION: For a single endoscopist, increased DBE experience with number of performed procedures is associated with increased efficiency and decreased resource utilization.
Collapse
Affiliation(s)
- Neal C Patel
- Neal C Patel, Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, AZ 85259, United States
| | | | | | | | | | | |
Collapse
|
|
27
|
Messer I, May A, Manner H, Ell C. Prospective, randomized, single-center trial comparing double-balloon enteroscopy and spiral enteroscopy in patients with suspected small-bowel disorders. Gastrointest Endosc 2013; 77:241-9. [PMID: 23043851 DOI: 10.1016/j.gie.2012.08.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 08/16/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Double-balloon enteroscopy (DBE) is an established method in diagnostic and therapeutic small-bowel enteroscopy. OBJECTIVE Spiral enteroscopy (SE) appears to be a promising new technique. A randomized, prospective study was conducted to compare both methods. DESIGN Randomized, prospective study. SETTING Single tertiary referral center. PATIENTS Between September 2009 and March 2011, 26 patients with suspected mid-GI disorders completed the study. INTERVENTIONS Patients were randomly assigned to DBE or SE. The oral examination was conducted first, with the deepest point reached being marked with India ink. An additional anal examination followed the day after, with the aim of reaching the ink mark. MAIN OUTCOME MEASUREMENTS The primary endpoint of the study was the rate of complete enteroscopies achieved. RESULTS The rate of complete enteroscopies with DBE was 12 times the rate achieved with SE (8% in the SE group and 92% in the DBE group; P = .002). With regard to the secondary study criteria, much longer examination times but greater depths of insertion were associated with DBE. There were no statistically significant differences in the diagnostic or therapeutic outcomes between the SE and DBE groups (diagnostic yield, P = .428; therapeutic yield, P = 1.0; Fisher exact test). One perforation occurred during an anal examination as a relevant adverse event in SE. LIMITATIONS Single-center study, small sample size. CONCLUSION SE does not represent an alternative to DBE with regard to the depth of insertion or the rate of complete enteroscopies achieved. However, SE is advantageous in that it involves significantly shorter examination times. Further technical improvements will be necessary before SE can compete with DBE for complete enteroscopies.
Collapse
Affiliation(s)
- Insa Messer
- Department of Internal Medicine II, HSK Wiesbaden (Teaching Hospital of the University of Mainz), Wiesbaden, Germany
| | | | | | | |
Collapse
|
|
28
|
Jensen M, Mysore K, El-Abiad R, Rahhal R. Double balloon enteroscopy in children: a case series highlighting risks, and a review of the literature. Frontline Gastroenterol 2013; 4:82-86. [PMID: 28839704 PMCID: PMC5369781 DOI: 10.1136/flgastro-2012-100229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 08/26/2012] [Accepted: 09/23/2012] [Indexed: 02/04/2023] Open
Abstract
AIM Double balloon enteroscopy (DBE) is a relatively new endoscopic technique that allows endoscopic access into the small intestine. It has been studied in adults, but the literature remains scarce in the paediatric age group. METHODS We retrospectively assessed our experience with DBE in children. RESULTS We describe four procedures performed on three patients. The diagnostic yield was high (100%) with one major complication (perforation) encountered. A review of the benefits and risks in this cohort, and the available literature is included. CONCLUSIONS DBE is a promising endoscopic modality in children, but some aspects remain unanswered. There is a great need for a prospective study to better assess benefit and risk in this population.
Collapse
Affiliation(s)
- Melissa Jensen
- Division of Pediatric Gastroenterology, University of Iowa Children's Hospital, Iowa City, Iowa, USA
| | - Krupa Mysore
- Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa, USA
| | - Rami El-Abiad
- Department of Internal Medicine, Division of Gastroenterology, University of Iowa, Iowa City, Iowa, USA
| | - Riad Rahhal
- Division of Pediatric Gastroenterology, University of Iowa Children's Hospital, Iowa City, Iowa, USA
| |
Collapse
|
|
29
|
Efthymiou M, Desmond PV, Brown G, La Nauze R, Kaffes A, Chua TJ, Taylor ACF. SINGLE-01: a randomized, controlled trial comparing the efficacy and depth of insertion of single- and double-balloon enteroscopy by using a novel method to determine insertion depth. Gastrointest Endosc 2012; 76:972-80. [PMID: 22980289 DOI: 10.1016/j.gie.2012.06.033] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 06/26/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Single-balloon enteroscopy (SBE) was introduced as an alternative to double-balloon enteroscopy (DBE) for the investigation and management of small-bowel conditions. To date, there is only 1 randomized, controlled trial comparing SBE and DBE in a Western population. OBJECTIVE To compare the 2 instruments in a Western population to assess for differences in clinical outcomes and insertion depth (ID). A novel method to determine ID by counting folds on withdrawal was used. DESIGN Multicenter, randomized, controlled trial. SETTING University hospitals in Melbourne and Sydney, Australia. PATIENTS Patients with suspected or proven small-bowel disease. INTERVENTIONS SBE and DBE. MAIN OUTCOME MEASUREMENT The primary endpoint was diagnostic yield (DY). Secondary endpoints were therapeutic yield (TY), procedure times, and ID. An intention-to-treat analysis was performed. RESULTS A total of 116 patients were screened, and 107 patients were enrolled between July 2008 and June 2010, in whom 119 procedures were undertaken (53 SBEs and 66 DBEs). DY was 57% for SBE and 53% for DBE (P = .697). TY was 32% for SBE and 26% for DBE (P = .490). The median enteroscopy times were identical for SBE and DBE at 60 minutes. The mean ID by the fold-counting method for antegrade procedures was 201.1 folds for SBE and 258.6 folds for DBE (P = .046). After multiple comparisons adjustment, this difference did not reach statistical significance. Mean IDs by using the visual estimation method for SBE and DBE were, respectively, 72.1 cm and 75.2 cm (P = .835) for retrograde procedures and 203.8 cm and 234.1 cm (P = .176) for antegrade procedures. LIMITATIONS Unable to reach target sample size, mostly single-center recruitment, novel method to determine ID, which requires further validation. CONCLUSIONS SBE has DY, TY, and procedure times similar to those of DBE. There were no statistically significant differences in ID between SBE and DBE. By using the fold-counting method for antegrade procedures, the estimated IDs for SBE and DBE were 201.1 folds versus 258.6 folds (P = .046; P = not significant after adjustment for multiple comparisons). ( CLINICAL TRIAL REGISTRATION NUMBER ACTRN12609000917235.).
Collapse
Affiliation(s)
- Marios Efthymiou
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | | | | | | | | | | | | |
Collapse
|
|
30
|
Williamson JB, Judah JR, Gaidos JKJ, Collins DP, Wagh MS, Chauhan SS, Zoeb S, Buscaglia JM, Yan H, Hou W, Draganov PV. Prospective evaluation of the long-term outcomes after deep small-bowel spiral enteroscopy in patients with obscure GI bleeding. Gastrointest Endosc 2012; 76:771-8. [PMID: 22771101 DOI: 10.1016/j.gie.2012.05.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 05/16/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Spiral enteroscopy can be safe and effective in the short term for evaluation of obscure GI bleeding, but long-term data are lacking. OBJECTIVE To assess the long-term clinical outcomes after deep small-bowel spiral enteroscopy performed for obscure GI bleeding. DESIGN Prospective cohort study. SETTING Academic referral center. PATIENTS This study included 78 patients who underwent antegrade spiral enteroscopy for evaluation of obscure GI bleeding. INTERVENTION Diagnostic spiral enteroscopy with hemostatic therapeutic maneuvers applied as indicated. MAIN OUTCOME MEASUREMENTS Postprocedure evidence of recurrent overt GI bleeding, blood transfusion requirements, need for iron supplementation, serum hemoglobin values, and the need for additional therapeutic procedures. RESULTS Long-term follow-up data (mean [± standard deviation] 25.3 ± 7.5 months; range 12.9-38.8 months) were obtained in 61 patients (78%). Among those with long-term follow-up data, overt bleeding before spiral enteroscopy was present in 62%, compared with 26% in the follow-up period (P < .0001). The mean (± SD) hemoglobin value increased from 10.6 ± 1.8 to 12.6 ± 1.9 g/dL (P < .0001). Blood transfusion requirements decreased by a mean of 4.19 units per patient (P = .0002), and the need for iron supplementation (P = .0487) and additional procedures (P < .0001) decreased in the follow-up period. There were 8 adverse events (9%) (7 mild, 1 moderate). LIMITATIONS Single-center study, intervention bias. CONCLUSION In patients with obscure GI bleeding, deep small-bowel spiral enteroscopy is safe and effective in reducing the incidence of overt bleeding. An increase in hemoglobin values along with a decrease in blood transfusion requirement, need for iron supplementation, and need for additional therapeutic procedures were found over long-term follow-up. ( CLINICAL TRIAL REGISTRATION NUMBER NCT00861263.).
Collapse
Affiliation(s)
- J Blair Williamson
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
31
|
Rahmi G. Consensus en endoscopie digestive de la SFED : exploration de l’intestin grêle par entéroscopie. ACTA ENDOSCOPICA 2012; 42:264-266. [DOI: 10.1007/s10190-012-0264-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
|
32
|
Sanaka MR, Navaneethan U, Kosuru B, Yerneni H, Lopez R, Vargo JJ. Antegrade is more effective than retrograde enteroscopy for evaluation and management of suspected small-bowel disease. Clin Gastroenterol Hepatol 2012; 10:910-6. [PMID: 22610006 DOI: 10.1016/j.cgh.2012.04.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 04/02/2012] [Accepted: 04/26/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Antegrade and retrograde enteroscopy are useful for evaluating the proximal and distal small bowel, respectively. We compared the diagnostic yield, therapeutic yield, and complications of antegrade and retrograde enteroscopy. METHODS We performed a retrospective review of a prospectively maintained database of patients who underwent small-bowel enteroscopy at our institution from January 2008 to August 2009. All enteroscopies were performed using single-balloon enteroscopy (SBE), double-balloon enteroscopy (DBE), or spiral enteroscopy (SE). A total of 250 enteroscopies were performed; 182 were antegrade (91 SBE, 52 DBE, and 39 SE) and 68 were retrograde (23 SBE, 37 DBE, and 8 SE). The mean age of the patients was 61.5 ± 15.8 years. RESULTS The most common indication for small-bowel endoscopy was obscure gastrointestinal bleeding (n = 83). The diagnostic yield was significantly higher for antegrade than retrograde enteroscopy (63.7% vs 39.7%; P < .001). Antegrade procedures were of shorter duration than retrograde enteroscopy (44.3 ± 22.0 vs 58.9 ± 29.7 min; P < .001), and the mean depth of maximal insertion was significantly greater with antegrade endoscopy (231.8 ± 122.1 vs 103.4 ± 102.8 cm; P < .001). The therapeutic yield also was significantly higher for anterograde enteroscopy than retrograde enteroscopy (55.5% vs 44.1%; P < .001). There were no significant differences in complications. CONCLUSIONS Antegrade enteroscopy appears to provide a higher diagnostic and therapeutic yield than retrograde enteroscopy in patients with suspected small-bowel disease.
Collapse
Affiliation(s)
- Madhusudhan R Sanaka
- Department of Gastroenterology, Digestive Disease Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | | | | | | | | | | |
Collapse
|
|
33
|
Lenz P, Domagk D. Double- vs. single-balloon vs. spiral enteroscopy. Best Pract Res Clin Gastroenterol 2012; 26:303-13. [PMID: 22704572 DOI: 10.1016/j.bpg.2012.01.021] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Accepted: 01/19/2012] [Indexed: 01/31/2023]
Abstract
Starting with the introduction of the double-balloon enteroscope in 2001, two more techniques have been successfully developed for small bowel investigation (single-balloon enteroscopy, spiral enteroscopy). To compare the different enteroscopy systems, within this review, 68 studies were analyzed and put into context. The procedural characteristics (mean insertion depth, diagnostic yields, adverse events) were comparable for DBE, SBE or SE. The higher panenteroscopy rate in DBE might not have any clinical relevance. Therapeutic procedures, such as argon-plasma coagulation, polypectomy, dilation therapy and foreign body extraction are described with the DBE and SBE procedure. With regard to the present literature, the balloon-assisted devices as well as spiral enteroscopy technique seem to be equally suitable in clinical routine for imaging of the small bowel. The choice of the method should be based on availability, physicians' experience and clinical implications. Future randomized, controlled trials with large numbers of patients are needed to work out the subtleties of every single method.
Collapse
Affiliation(s)
- Philipp Lenz
- Department of Medicine B, University of Muenster, Albert-Schweitzer-Campus 1, A1, 48149 Muenster, Germany.
| | | |
Collapse
|
|
34
|
Kaffes AJ. Advances in modern enteroscopy therapeutics. Best Pract Res Clin Gastroenterol 2012; 26:235-46. [PMID: 22704567 DOI: 10.1016/j.bpg.2012.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 02/24/2012] [Accepted: 03/08/2012] [Indexed: 02/07/2023]
Abstract
Advances in modern enteroscopy have been largely due to endoscope development but also through the improved availability of endoscopic accessories along with improved understanding in their application. Device assisted enteroscopy began with the double balloon system in 2001 and was quickly followed by single balloon enteroscopy and spiral enteroscopy. These tools revolutionised deep small bowel endoscopy and allowed for the delivery of virtually all known therapeutic endoscopy intervention to almost all segments of the small bowel. This review covers the types of interventions in regards to indications, methods and their safety profiles as well as reviewing the various device assisted endoscopes available and their attributes.
Collapse
Affiliation(s)
- Arthur John Kaffes
- Royal Prince Alfred Hospital, AW Morrow Gastroenterology and Liver Centre, Gastroenterologist, Missenden Rd, Camperdown, NSW 2050, Australia.
| |
Collapse
|
|
35
|
Small Bowel Bleeding. GASTROINTESTINAL BLEEDING 2012. [DOI: 10.1002/9781444398892.ch10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
|
36
|
Teshima CW, May G. Small bowel enteroscopy. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2012; 26:269-75. [PMID: 22590700 PMCID: PMC3352842 DOI: 10.1155/2012/571235] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Accepted: 07/25/2011] [Indexed: 12/17/2022]
Abstract
Over the past decade, the advent of capsule endoscopy and balloon-assisted enteroscopy has revolutionized the approach to small intestinal diseases. The small bowel is no longer out of reach, and has fallen within the diagnostic and therapeutic realm of the gastrointestinal endoscopist. Double-balloon enteroscopy was the first type of balloon-assisted endoscopy and is the method for which there are the most data. Single-balloon enteroscopy has since been introduced as an alternative balloon-assisted method, followed more recently by the development of spiral overtube-assisted enteroscopy. The purpose of the present article is to review these methods of small bowel enteroscopy and to discuss the latest developments. While the investigation of small bowel diseases cannot be addressed without considering the central role of capsule endoscopy, a detailed assessment is beyond the scope of the present article, and capsule endoscopy will only be discussed as it pertains to enteroscopy.
Collapse
Affiliation(s)
- Christopher W Teshima
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta T6G 2X8, Canada.
| | | |
Collapse
|
|
37
|
Maranki JL, Haluszka O. Endoscopic therapies for small-bowel bleeding. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2012. [DOI: 10.1016/j.tgie.2012.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
|
38
|
Chalazan B, Gostout CJ, Song LMWK, Enders FT, Rajan E. Use of Capsule Small Bowel Transit Time to Determine the Optimal Enteroscopy Approach. Gastroenterology Res 2012; 5:39-44. [PMID: 27785178 PMCID: PMC5051164 DOI: 10.4021/gr404w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2012] [Indexed: 12/22/2022] Open
Abstract
Background Capsule small bowel transit time (SBTT) is used to select the most effective enteroscopy approach when targeting capsule endoscopy (CE) findings. Aim of this study was to determine if capsule SBTT can be used to guide the choice of enteroscopy technique for reaching CE abnormalities. Methods Single center, retrospective study involving 60 patients. Data were abstracted from medical records of patients with abnormal CE who proceeded to enteroscopy which included push enteroscopy (PE) single balloon enteroscopy (SBE) and double balloon enteroscopy (DBE). Results Ninety five findings were documented on CE with presumed identification of 56 (59%) of these abnormalities by enteroscopy. Majority were angioectasias on CE (42%) and enteroscopy (59%). Optimal cutoff values for selection of enteroscopy procedure were: 0-21% SBTT for PE (80% sensitivity, 74% specificity, 83% PPV); 0 - 36% SBTT for antegrade SBE (93% sensitivity, 40% specificity, 82% PPV); 0 - 57% SBTT for antegrade DBE (75% sensitivity, 80% specificity, 75% PPV); and 74 - 100% SBTT for retrograde DBE (88% sensitivity, 78% specificity, 78% PPV). Conclusion Capsule SBTT may be used to guide the selection of enteroscopy approach. PE, antegrade SBE, antegrade DBE and retrograde DBE are optimal when abnormalities on CE are seen at ≤ 21%, ≤ 36%, ≤ 57% and ≥ 74% SBTT respectively.
Collapse
Affiliation(s)
- Brandon Chalazan
- Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, USA
| | - Christopher J Gostout
- Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, USA
| | - Louis M Wong Kee Song
- Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, USA
| | - Felicity T Enders
- Health Sciences Research, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, USA
| | - Elizabeth Rajan
- Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, USA
| |
Collapse
|
|
39
|
Shishido T, Oka S, Tanaka S, Imagawa H, Takemura Y, Yoshida S, Chayama K. Outcome of patients who have undergone total enteroscopy for obscure gastrointestinal bleeding. World J Gastroenterol 2012; 18:666-72. [PMID: 22363138 PMCID: PMC3281224 DOI: 10.3748/wjg.v18.i7.666] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 04/20/2011] [Accepted: 04/27/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the diagnostic success and outcome among patients with obscure gastrointestinal bleeding who underwent total enteroscopy with double-balloon endoscopy.
METHODS: Total enteroscopy was attempted in 156 patients between August 2003 and June 2008 at Hiroshima University Hospital and achieved in 75 (48.1%). It is assessed whether sources of bleeding were identified, treatment methods, complications, and 1-year outcomes (including re-bleeding) after treatment, and we compared re-bleeding rates among patients.
RESULTS: The source of small bowel bleeding was identified in 36 (48.0%) of the 75 total enteroscopy patients; the source was outside the small bowel in 11 patients (14.7%) and not identified in 28 patients (37.3%). Sixty-one of the 75 patients were followed up for more than 1 year (27.2 ± 13.3 mo). Four (6.6%) of these patients showed signs of re-bleeding during the first year, but bleeding did not recur after treatment. Although statistical significance was not reached, a marked difference was found in the re-bleeding rate between patients in whom total enteroscopy findings were positive (8.6%, 3/35) and negative (3.8%, 1/26) (3/35 vs 1/26, P = 0.63).
CONCLUSION: A good outcome can be expected for patients who undergo total enteroscopy and receive proper treatment for the source of bleeding in the small bowel.
Collapse
|
|
40
|
Long-term outcome of patients treated with double balloon enteroscopy for small bowel vascular lesions. Am J Gastroenterol 2012; 107:240-6. [PMID: 21946281 DOI: 10.1038/ajg.2011.325] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Early rebleeding rate after endoscopic therapy with double balloon enteroscopy (DBE) of hemorrhagic small bowel vascular lesions (SBVL) varies between 10 and 50%. In recent reports, long-term follow-up of patients have been described but rebleeding risk factors are still not well established. The aim of the current study was to identify long-term treatment success rate and rebleeding risk factors after DBE therapy in a large cohort. METHODS We conducted a single-center, retrospective cohort study in a large French tertiary-referral center between January 2004 and December 2007. RESULTS Among 261 patients presenting with obscure gastrointestinal bleeding (OGIB), SBVL was present in 133 patients and was treated successfully in 129 (97%) using mainly argon plasma coagulation. Ninety-eight patients were followed up for a mean period of 22.6±13.9 months (range 1-52). Rebleeding rate was 46% (45/98 patients) at 36 months. On multivariate analysis, the total number of observed lesions (hazard ratio (HR): 1.15, 95% confidence interval (CI): 1.06-1.25, P=0.001) and the presence of a valvular and/or arrhythmic cardiac disease (HR: 2.50, 95% CI: 1.29-4.87, P=0.007) were significantly associated with the risk of rebleeding. Complication rate of therapeutic DBE was 2.3% with no mortality. CONCLUSIONS Endoscopic therapy using DBE for SBVL in patients with recurrent OGIB allows a long-term remission in more than half of the patients. Independent rebleeding risk factors after a first endoscopic therapy are an increased number of SBVL and an associated valvular/arrhythmic heart disease.
Collapse
|
|
41
|
Riccioni ME, Cianci R, Urgesi R, Bizzotto A, Spada C, Rizzo G, Coco C, Costamagna G. Advance in diagnosis and treatment of small bowel tumors: a single-center report. Surg Endosc 2012; 26:438-441. [PMID: 21909852 DOI: 10.1007/s00464-011-1896-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 08/18/2011] [Indexed: 01/23/2023]
Abstract
BACKGROUND The past decade has seen significant advances in the evaluation of the small bowel, long considered as the "black box" in gastroenterology. The development of several endoscopic techniques, including capsule endoscopy (CE) and double (DBE)- and single (SBE)-balloon enteroscopy, has improved the evaluation of this part of the gut and led to reach a more precise preoperative diagnosis of small-bowel tumors. These rare tumors were previously diagnosed only after laparotomy, although laparoscopic advanced surgery can be used for minimally invasive therapeutic approach in these patients. This study was designed to evaluate the diagnostic and therapeutic impact of endoscopic procedures on small-bowel tumors. METHODS During October 2010, 148 SBE procedures were performed; in 14 patients (7 males and 7 females, mean age 58.8 years; range 37-82 years) who suffered from obscure gastrointestinal bleeding, with previous negative upper and lower GI endoscopy, a diagnosis of small-bowel tumor was suspected according to CT scan (7 cases) and/or CE (11 patients). Then, an enteroscopy was performed. RESULTS Multiple biopsies were taken in 9 cases; endoscopic tattoos were performed in 11 cases. After endoscopic procedures, histological examination showed melanoma in one case, adenocarcinoma in seven, and adenoma in one case. In 11 of 14 patients, a laparoscopic partial resection of small bowel involved was possible due to endoscopic tattoos. In one patient, the involvement of colic segment precluded a laparoscopic resection. In two patients, the laparoscopic resection was not possible for technical problems. Histological findings on resected specimens were indicative for melanoma in one case, gastrointestinal stromal tumor (GIST) in four cases, gastrointestinal autonomic nerve tumor (GANT) in one case, adenoma in one, and adenocarcinoma in seven cases. CONCLUSIONS New development of different endoscopic approaches to the small bowel has led to reach an earlier diagnosis of small-bowel tumors and a preoperative diagnosis with consequent minimally invasive surgical approach.
Collapse
Affiliation(s)
- M E Riccioni
- Digestive Endoscopy Unit, Catholic University, Largo A. Gemelli, 8, 00168, Rome, Italy
| | | | | | | | | | | | | | | |
Collapse
|
|
42
|
Riccioni ME, Urgesi R, Cianci R, Spada C, Nista EC, Costamagna G. Single-balloon push-and-pull enteroscopy system: does it work? A single-center, 3-year experience. Surg Endosc 2011; 25:3050-3056. [PMID: 21487872 DOI: 10.1007/s00464-011-1669-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2010] [Accepted: 03/07/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND The last decade has seen significant advances in the evaluation of the small bowel. Several endoscopic techniques have been developed in recent years: capsule endoscopy (CE), double-balloon enteroscopy (DBE), and, more recently, the single-balloon enteroscopy (SBE). The aim of this study was to evaluate diagnostic and therapeutic impact, safety, and feasibility of the SBE procedure after a 3-year experience. METHODS A total of 73 SBE procedures were performed from July 2006 to July 2009. The starting insertion route (oral or anal) of SBE was chosen according to the estimated location of the suspected lesions based on the clinical presentation and, in 48 patients, on the findings of CE. A total of 70 patients with obscure gastrointestinal bleeding (31), suspected malabsorption syndrome (12), polyposis syndromes (11), suspected Crohn's disease (9), and suspected gastrointestinal tumors (7) were recruited. RESULTS The SBE was not carried out in four patients because of technical problems. Multiple angiodysplasias were found and treated in 9 patients; Peutz-Jeghers syndrome, familial adenomatous polyposis (FAP), and multiple polypectomies were carried out in 8 patients; endoscopic tattoos were performed in 2 patients due to the large diameter of the polyps; and multiple biopsies was performed in only one patient. SBE diagnosed Crohn's disease in four patients, malabsorption syndromes in two, lymphangiectasia in two, eosinophilic enteritis in one, melanoma in one, and nonspecific inflammation in eight. A total of seven small-bowel tumors were diagnosed (all were tattooed). In 23/70 patients the exam was negative. No major complications occurred. CONCLUSION Single-balloon enteroscopy seems to be safe, useful, and highly effective in the diagnosis and therapy of several small-bowel diseases.
Collapse
Affiliation(s)
- M E Riccioni
- Digestive Endoscopy Unit, Catholic University of Rome, Largo A. Gemelli, 8, 00168 Rome, Italy
| | | | | | | | | | | |
Collapse
|
|
43
|
Lara LF, Singh S, Sreenarasimhaiah J. Initial experience with retrograde overtube-assisted enteroscopy using a spiral tip overtube. Proc (Bayl Univ Med Cent) 2011; 23:130-3. [PMID: 20396421 DOI: 10.1080/08998280.2010.11928600] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Overtube-assisted enteroscopy has expanded therapeutic options for the small bowel, but the effectiveness of spiral tip overtube-assisted endoscopy for retrograde small bowel evaluation is not known. This retrospective study reviewed the results of retrograde enteroscopy procedures among six consecutive patients. In these patients, cecal retroflexion was necessary to enter the terminal ileum when using an enteroscope, and 40 to 130 cm of the distal small bowel was intubated. The average procedure time was 52 minutes. The procedure was diagnostic in four patients, and successful endoscopic therapy was performed in three patients, including completion of a polypectomy at the ileocecal valve, resolution of a distal intestinal obstruction in a patient with cystic fibrosis, and a small bowel anastomotic stricture release. There were no procedure-related complications. Overtube-assisted enteroscopy with the spiral tip overtube allows for antegrade or retrograde evaluation of the small bowel. Pan-enteroscopy may become possible as the technique and equipment improve. The advantages of the different forms of overtube-assisted enteroscopy (spiral, single, and double balloon) need to be determined.
Collapse
Affiliation(s)
- Luis F Lara
- Division of Gastroenterology, Department of Internal Medicine, Baylor University Medical Center (Lara); and Division of Digestive and Liver Diseases, Department of Internal Medicine, The University of Texas Southwestern Medical Center (Singh, Sreenarasimhaiah)
| | | | | |
Collapse
|
|
44
|
Wu J, Zheng CF, Huang Y, Shao CH, Leung YK. Coordination and nursing care of pediatric patients undergoing double balloon enteroscopy. World J Gastroenterol 2011; 17:3049-53. [PMID: 21799652 PMCID: PMC3132257 DOI: 10.3748/wjg.v17.i25.3049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Revised: 03/02/2011] [Accepted: 03/09/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To review safety, efficacy, and proper nursing care of double-balloon enteroscopy (DBE) in pediatric patients with small intestinal disease.
METHODS: Our study included 37 patients with abdominal pain, diarrhea, passage of blood in the stools, and other symptoms, who underwent DBE from December 2006 to July 2010. DBE was retrograde in 36 procedures, antegrade in six, and from both ends in five. The diagnostic significance and salient points in nursing care are discussed in this article.
RESULTS: At least one lesion was discovered in 28 out of 37 patients, which yielded a positive diagnosis in 75.7% of cases. Good bowel preparation and skilled nursing care not only shortened the procedure time, but could also alleviate patient discomfort and enhance the quality of examination. No serious procedure-related complications were observed in any cases.
CONCLUSION: DBE is a new modality of endoscopic procedure that improves the standard of diagnosis and treatment of small bowel diseases in children. Good nursing care is essential to the successful execution of the procedure.
Collapse
|
|
45
|
Teshima CW, Aktas H, van Buuren HR, Kuipers EJ, Mensink PB. Retrograde double balloon enteroscopy: comparing performance of solely retrograde versus combined same-day anterograde and retrograde procedure. Scand J Gastroenterol 2011; 46:220-6. [PMID: 20923379 DOI: 10.3109/00365521.2010.521892] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Retrograde double balloon enteroscopy (DBE) is important for evaluating the distal small bowel, but it is more challenging compared to the oral route. Optimizing small bowel insertion may enhance the diagnostic utility of the examination. We sought to determine if insertion depths achieved with retrograde DBE when performed as an isolated procedure differed significantly from when performed immediately following anterograde DBE. MATERIAL AND METHODS A retrospective analysis was conducted of all retrograde DBE procedures performed at our center with comparisons made between "distal-only" DBE without preceding anterograde DBE and "combined" DBE after a prior same-day anterograde DBE. RESULTS Two hundred ninety retrograde DBE procedures were performed in 264 patients over 5 years. Success of terminal ileal intubation exceeded 95%. The mean insertion depth into the distal small bowel differed significantly with 112 cm (95% CI 95-129) in the "distal-only" group and 92 cm (95% CI 85-98) in the "combined" group (p = 0.01), with a trend toward a corresponding increased diagnostic yield of 48% versus 37%, respectively (p = 0.15). Multivariate regression analysis identified both insertion route strategy (distal-only > combined; p = 0.01) and type of DBE endoscope (diagnostic > therapeutic; p = 0.02) as significant predictors of retrograde insertion depth. CONCLUSIONS The insertion depth of retrograde DBE is significantly greater when carried out as a separate distal procedure and not in combination with a preceding anterograde DBE, and when performed using a diagnostic as opposed to the therapeutic DBE endoscope. This increased retrograde depth of insertion may be associated with an increased diagnostic yield.
Collapse
Affiliation(s)
- Christopher W Teshima
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
|
46
|
Abstract
Nowadays, 5 nonsurgical flexible endoscopic techniques are available for small bowel endoscopy: push enteroscopy (PE), balloon-assisted enteroscopy using 2 balloons (double-balloon enteroscopy [DBE]) or 1 balloon (single-balloon enteroscopy [SBE]), balloon-guided enteroscopy (BGE), and spiral enteroscopy (SE). PE is a cost-saving, easy, and fast procedure for the examination of the proximal jejunum, but for a deep small bowel endoscopy, the other flexible enteroscopic techniques are required. BGE does not play a considerable role in deep small bowel endoscopy. DBE is the oldest flexible enteroscopic technique. Actually, the balloon-assisted enteroscopy (BAE) techniques with one balloon (SBE) or two balloons (DBE) are the mainly used techniques. DBE has become established throughout the world for diagnostic and therapeutic examinations of the small bowel and is now used universally in clinical routine work. DBE is still regarded as the gold standard nonsurgical procedure for deep small bowel endoscopy, because it provides the highest rates of complete enteroscopy, which becomes increasingly useful. The recently introduced SE technique represents a promising method but still needs technical improvement. Larger prospective studies on SE and prospective studies comparing the 3 systems (DBE, SBE, SE) are awaited before conclusive assessments can be made.
Collapse
Affiliation(s)
- Andrea May
- Department of Internal Medicine II, HSK Wiesbaden, Ludwig-Erhard-Strasse 100, 65199 Wiesbaden, Germany.
| |
Collapse
|
|
47
|
Li XB, Dai J, Chen HM, Zhuang J, Song Y, Gao YJ, Ge ZZ. A novel modality for the estimation of the enteroscope insertion depth during double-balloon enteroscopy. Gastrointest Endosc 2010; 72:999-1005. [PMID: 21034900 DOI: 10.1016/j.gie.2010.07.045] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 07/22/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND Until now, the insertion depth of the enteroscope during double-balloon enteroscopy (DBE) could only be estimated. However, the currently available methods have limitations, and development of newer, simple, and accurate modalities is needed. OBJECTIVE To evaluate the accuracy of a novel method for evaluation of enteroscope insertion depth during DBE. DESIGN Prospective, single-center cohort study. SETTING Tertiary referral university hospital. PATIENTS Fifty-one patients who had lesions found during 41 antegrade and 10 retrograde DBEs and treated by surgery were enrolled in this study. INTERVENTIONS The length of the ligament of Treitz/ileocecal valve lesion was estimated by adding the forward enteroscope length during each cycle of passage and by calculating the overtube insertion length (every 5 cm of overtube advancement means 40 cm of enteroscope advancement based on preliminary observations) during DBE, respectively, and was evaluated at surgery. MAIN OUTCOME MEASUREMENTS The length from the ligament of Treitz/ileocecal valve to the lesion. RESULTS Surgical evaluation was used as the standard. Regardless of insertion route, the mean difference from surgery in evaluation of enteroscope insertion length between using the enteroscope method and the overtube method was 19 cm (range 0-50 cm) and 17 cm (range 0-60 cm), respectively (P > .05). LIMITATIONS Small number of patients with a case series study design. CONCLUSIONS Calculating the length of the overtube passage is accurate, and it is simple to estimate the insertion depth of the enteroscope during DBE, which is useful in clinical practice.
Collapse
Affiliation(s)
- Xiao-Bo Li
- Department of Gastroenterology, Shanghai Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute of Digestive Disease Shanghai, China
| | | | | | | | | | | | | |
Collapse
|
|
48
|
Abstract
OBJECTIVES Double-balloon enteroscopy (DBE) is a newly developed endoscopic modality for diagnosis and treatment of small bowel disorders. Most publications on DBE are from adult medical centers. Publication related to the use and application of DBE in children and adolescents is limited. We present our experience with the use of DBE in the pediatric age group. PATIENTS AND METHODS We reviewed patient information on all of the DBE procedures performed in 2006 through 2008 at a single tertiary pediatric referral center in Columbus, Ohio. Compiled information included patient demographics, procedure indications, diagnostic and therapeutic results, and procedure-associated complications or adverse events. RESULTS Thirteen DBE procedures were performed on eleven 8- to 20-year-old patients. Procedure indications were based on suspicion for organic small bowel pathology after an exhaustive diagnostic evaluation including upper and lower endoscopy failed to uncover an etiology. Clinically significant lesions were identified in 46% (6/13) of the procedures performed. No serious procedure-related complications occurred. Self-limited postprocedure abdominal pain and discomfort from gaseous distension was observed in several patients. CONCLUSIONS DBE appears to be a safe endoscopic modality for the diagnosis and treatment of children and adolescents with suspected small bowel disease. However, performance should be selectively reserved for patients with a high suspicion for small bowel pathology, in which other less invasive techniques have failed to adequately diagnose and treat a patient's disease.
Collapse
|
|
49
|
Judah JR, Collins D, Gaidos JK, Hou W, Forsmark CE, Draganov PV. Prospective evaluation of gastroenterologist-guided, nurse-administered standard sedation for spiral deep small bowel enteroscopy. Dig Dis Sci 2010; 55:2584-91. [PMID: 20632098 DOI: 10.1007/s10620-010-1335-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 06/21/2010] [Indexed: 12/15/2022]
Abstract
BACKGROUND Sedation of patients for deep small bowel enteroscopy presents unique challenges and is traditionally provided by anesthesiologists. No study has directly evaluated gastroenterologist-guided, nurse-administered sedation for deep enteroscopy. Further, no comparison exists between gastroenterologist-guided versus anesthesiologist-guided sedation during deep enteroscopy. AIMS To evaluate safety and efficacy of performing deep (spiral) enteroscopy using gastroenterologist-guided sedation and compare outcomes between patients receiving gastroenterologist-guided and anesthesiologist-guided sedation. METHODS This prospective case series contains 91 consecutive patients who underwent deep enteroscopy with spiral Endo-Ease Discovery SB overtube. Of the patients, 64 received gastroenterologist-guided and 27 received anesthesiologist-guided sedation. RESULTS In the 64 patients receiving gastroenterologist-guided sedation, successful completion occurred in 59 of 64 enteroscopies (92.2%). Mean insertion depth was 231.0+/-85.8 cm beyond the ligament of Treitz. Total procedure time was 39.9+/-15.7 min (diagnostic time 34.7+/-12.3 min; therapy time 5.2+/-8.9 min). Positive findings were noted in 32 cases (50.0%), with therapy performed in 27 cases (42.2%). Six minor complications occurred. Compared to the anesthesiologist-guided sedation group, there was no difference in patient characteristics except mean American Society of Anesthesiologists score (2.5+/-0.5 in gastroenterologist-guided group versus 2.7+/-0.6 in anesthesiologist-guided group; p=0.046) and presence of adhesions (ten in gastroenterologist-guided group and zero in anesthesiologist-guided group; p=0.030). Outcomes for both groups were not significantly different except for shorter times in the gastroenterologist-guided group (39.9+/-15.7 min versus 46.0+/-12.1 min; p=0.047) and more frequent findings in the anesthesiologist-guided group (50.0% vs. 74.1%; p=0.034). CONCLUSIONS Deep enteroscopy using the spiral overtube can be successfully and safely accomplished with gastroenterologist-guided, nurse-administered standard sedation.
Collapse
Affiliation(s)
- J R Judah
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Florida College of Medicine, 1600 SW Archer Rd, Room HD 602, PO Box 100214, Gainesville, FL, 32610, USA,
| | | | | | | | | | | |
Collapse
|
|
50
|
Kondo J, Iijima H, Abe T, Komori M, Hiyama S, Ito T, Nakama A, Tominaga K, Kubo M, Suzuki K, Iwanaga Y, Ebara R, Takeda A, Tsuji S, Nishida T, Tsutsui S, Tsujii M, Hayashi N. Roles of double-balloon endoscopy in the diagnosis and treatment of Crohn's disease: a multicenter experience. J Gastroenterol 2010; 45:713-720. [PMID: 20174832 DOI: 10.1007/s00535-010-0216-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 01/26/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND Double-balloon endoscopy (DBE) examinations are not yet widely accepted as routine procedures for examining the small bowel of patients with Crohn's disease (CD). AIM To evaluate the feasibility and usefulness of DBE for CD in tertiary-care hospitals. METHODS Between July 2004 and September 2008, 1444 DBE procedures were performed for 704 patients in 6 tertiary-care hospitals. Patient profile, indication, diagnosis and treatment of DBE were evaluated using a multicenter database. RESULTS DBE examinations were most frequently performed in 75 patients with CD, corresponding to 10.5% of all the patients examined by DBE. Fifty patients were diagnosed with CD before DBE, while DBE was performed for the diagnosis of 25 new CD patients. Small bowel lesions were often detected even when the terminal ileum was not involved. In the 75 patients, 21 patients were asymptomatic at the time of DBE examinations. Active inflammatory lesions were detected in 51.2% of the CD patients, and were even detected in 33.3% of the asymptomatic CD patients. The treatment was altered in 53.3% of the CD patients after the DBE evaluation. No severe complications were experienced. CONCLUSIONS DBE procedures can be safely performed in patients with CD and should be considered for the precise evaluation of and to determine the treatment strategy for CD.
Collapse
Affiliation(s)
- Jumpei Kondo
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 K1 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|