This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Xiao-Bo Li, Zhi-Zheng Ge, Jun Dai, Yun-Jie Gao, Wen-Zhong Liu, Yun-Biao Hu, Shu-Dong Xiao, Department of Gastroenterology, Renji Hospital, Medical college of Shanghai Jiaotong University; Shanghai Institute of Digestive Diseases, Shanghai 200001, China
Supported by: Key Subject Foundation of Shanghai, China, No. Y0205.
Correspondence to: Zhi-Zheng Ge, Department of Gastroenterology, Renji Hospital, Medical college of Shanghai Jiaotong University, Shanghai 200001, China. zhizhengge@yahoo.com.cn
Received: April 7, 2006 Revised: May 1, 2006 Accepted: May 11, 2006 Published online: June 28, 2006
AIM: To evaluate the role of capsule endoscopy in determining the route for double-balloon enteroscopy.
METHODS: Twenty patients with negative or equivocal evaluation after capsule endoscopy received double-balloon enteroscopy (under anesthesia with propofol) by oral or anal route. The choice of the insertion route of the endoscope for the first attempt at double-balloon enteroscopy was made according to a time index (the value of the time in minutes for transit of the capsule endoscope from the pylorus to the lesion divided by the value of the time for transit of the capsule endoscope from the pylorus to the cecum). An anal route was indicated when the time index was more than 0.50. A second procedure was undertaken through the alternative route several days later when the lesion of interest was not found during the first one. The accuracy for choosing the route of double-balloon enteroscopy according to the capsule time index was then analyzed.
RESULTS: Five patients with negative evaluation after capsule endoscopy received double-balloon enteroscopy, and a lesion was detected in 1 of these patients when a second procedure by the anal route was performed. Fifteen patients with equivocal evaluation after capsule endoscopy received double-balloon enteroscopy, and the suspected findings were confirmed in 12 (80.0%) of these patients by double-balloon enteroscopy combined with pathological examination. An anal route of the endoscopy at the first attempt with double-balloon enteroscopy was selected on 4 patients (0.99, 0.8, 0.65, and 0.59, respectively), and the lesions were detected in the latter two (with a time index of 0.65 and 0.59, respectively) when a second procedure by the oral route was performed. If the time index of more than 0.75 (with consideration of another report) was used, no further attempts would be needed in these two patients, and the lesions of the other two patients were assumed to be located in the distal ileum and reached by double-balloon endoscopy via anal route exactly.
CONCLUSION: The outcome of capsule endoscopy can direct the choice of routes for double-balloon enteroscopy. A time index of more than 0.75 appears to indicate an anal route as the first procedure.
Citation: Li XB, Ge ZZ, Dai J, Gao YJ, Liu WZ, Hu YB, Xiao SD. Directive role of capsule endoscopy in determining the route for double-balloon enteroscopy. Shijie Huaren Xiaohua Zazhi 2006; 14(18): 1828-1832
Yamamoto H, Yano T, Kita H, Sunada K, Ido K, Sugano K. New system of double-balloon enteros-copy for diagnosis and treatment of small intestinal disorders.Gastroenterology. 2003;125:1556.
[PubMed] [DOI]
Di Caro S, May A, Heine DG, Fini L, Landi B, Petruzziello L, Cellier C, Mulder CJ, Costamagna G, Ell C. The European experience with double-balloon enteroscopy: indications, methodo-logy, safety, and clinical impact.Gastrointest Endosc. 2005;62:545-550.
[PubMed] [DOI]
Ell C, May A, Nachbar L, Cellier C, Landi B, di Caro S, Gasbarrini A. Push-and-pull enteroscopy in the small bowel using the double-balloon technique: results of a prospective European multicenter study.Endoscopy. 2005;37:613-616.
[PubMed] [DOI]
May A, Nachbar L, Ell C. Double-balloon enteroscopy (push-and-pull enteroscopy) of the small bowel: feasibility and diagnostic and therapeutic yield in patients with suspected small bowel disease.Gastrointest Endosc. 2005;62:62-70.
[PubMed] [DOI]
Su MY, Liu NJ, Hsu CM, Chiu CT, Chen PC, Lin CJ. Double balloon enteroscopy-the last blind-point of the gastrointestinal tract.Dig Dis Sci. 2005;50:1041-1045.
[PubMed] [DOI]
Sunada K, Yamamoto H, Kita H, Yano T, Sato H, Hayashi Y, Miyata T, Sekine Y, Kuno A, Iwamoto M. Clinical outcomes of enteroscopy using the double-balloon method for strictures of the small intestine.World J Gastroenterol. 2005;11:1087-1089.
[PubMed] [DOI]
May A, Nachbar L, Schneider M, Neumann M, Ell C. Push-and-pull enteroscopy using the double-balloon technique: method of assessing depth of insertion and training of the enteroscopy technique using the Erlangen Endo-Trainer.Endoscopy. 2005;37:66-70.
[PubMed] [DOI]
Matsumoto T, Esaki M, Moriyama T, Nakamura S, Iida M. Comparison of capsule endoscopy and enteroscopy with the double-balloon method in patients with obscure bleeding and polyposis.Endoscopy. 2005;37:827-832.
[PubMed] [DOI]
May A, Nachbar L, Wardak A, Yamamoto H, Ell C. Double-balloon enteroscopy: preliminary experience in patients with obscure gastrointestinal bleeding or chronic abdominal pain.Endoscopy. 2003;35:985-991.
[PubMed] [DOI]
Ge ZZ, Hu YB, Xiao SD. Capsule endoscopy and push enteroscopy in the diagnosis of obscure gastrointestinal bleeding.Chin Med J (Engl). 2004;117:1045-1049.
[PubMed] [DOI]
Hadithi M, Heine GD, Jacobs MA, van Bodegraven AA, Mulder CJ. A prospective study comparing video capsule endoscopy with double-balloon enter-oscopy in patients with obscure gastrointestinal bleeding.Am J Gastroenterol. 2006;101:52-57.
[PubMed] [DOI]
Nakamura M, Niwa Y, Ohmiya N, Miyahara R, Ohashi A, Itoh A, Hirooka Y, Goto H. Preliminary comparison of capsule endoscopy and double-balloon enteroscopy in patients with suspected small-bowel bleeding.Endoscopy. 2006;38:59-66.
[PubMed] [DOI]
Gay G, Delvaux M, Fassler I. Outcome of capsule endoscopy in determining indication and route for push-and-pull enteroscopy.Endoscopy. 2006;38:49-58.
[PubMed] [DOI]
Carlo JT, DeMarco D, Smith BA, Livingston S, Wiser K, Kuhn JA, Lamont JP. The utility of capsule endoscopy and its role for diagnosing pathology in the gastrointestinal tract.Am J Surg. 2005;190:886-890.
[PubMed] [DOI]
Carey EJ, Fleischer DE. Investigation of the small bowel in gastrointestinal bleeding-enteroscopy and capsule endoscopy.Gastroenterol Clin North Am. 2005;34:719-734.
[PubMed] [DOI]
Bhuket T, Takami M, Fisher L. The use of wireless capsule endoscopy in clinical diagnostic gastroen-terology.Expert Rev Med Devices. 2005;2:259-266.
[PubMed] [DOI]
Triester SL, Leighton JA, Leontiadis GI, Fleischer DE, Hara AK, Heigh RI, Shiff AD, Sharma VK. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding.Am J Gastroenterol. 2005;100:2407-2418.
[PubMed] [DOI]
Rondonotti E, Herrerias JM, Pennazio M, Caunedo A, Mascarenhas-Saraiva M, de Franchis R. Complications, limitations, and failures of capsule endoscopy: a review of 733 cases.Gastrointest Endosc. 2005;62:712-716; quiz 752, 754.
[PubMed] [DOI]
Yamamoto H, Sekine Y, Sato Y, Higashizawa T, Miyata T, Iino S, Ido K, Sugano K. Total enteroscopy with a nonsurgical steerable double-balloon method.Gastrointest Endosc. 2001;53:216-220.
[PubMed] [DOI]
Yamamoto H, Kita H, Sunada K, Hayashi Y, Sato H, Yano T, Iwamoto M, Sekine Y, Miyata T, Kuno A. Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases.Clin Gastroenterol Hepatol. 2004;2:1010-1016.
[PubMed] [DOI]
