Published online Sep 16, 2022. doi: 10.4253/wjge.v14.i9.555
Peer-review started: April 16, 2022
First decision: May 12, 2022
Revised: May 21, 2022
Accepted: August 10, 2022
Article in press: August 10, 2022
Published online: September 16, 2022
Single balloon enteroscopy (SBE) is a procedure that has greatly improved the access to small bowel visualization, particularly of the mid and distal parts of the small bowel. In addition to being used as a diagnostic tool, SBE can also be used to perform a number of therapeutic interventions. SBE is a relatively safe procedure with a low incidence of complications and a good diagnostic and therapeutic yield. One of the most common indications generally seen is intestinal bleeding.
Since SBE is a relatively new procedure, there is still an absence of viable literature about it from the developing world countries like Pakistan. Due to the good yields from this procedure, proper adaptation of this technique in these places can greatly be used to improve healthcare outcomes particularly pertaining to small bowel problems by improving timely diagnosis and management.
To investigate the indications, procedures, findings, and safety of SBE procedures and to correlate their effects on the disease outcomes.
We performed a retrospective descriptive study at a tertiary care hospital in Pakistan and investigated all the SBE procedures carried out between July 2013 and December 2021. A total of 56 patients underwent 61 SBE procedures during this time period. We collected data using patient files and electronic health records using a structured proforma. It was interpreted and then categorized and analyzed using the SPSS software.
Our study population consisted of 56 patients who underwent 61 SBE procedures at a tertiary care hospital over the study period. The mean age of the sample was 50.93 ± 16.16 years and 53.6% of the sample was male. The most common comorbidities in the patient population were hypertension (39.3%) and diabetes mellitus (25.0%). The most common indications for conducting the SBE procedure were obscure gastrointestinal bleed (39.3%), chronic diarrhea (19.7%), and unexplained anemia (16.4%). Other indications included enteric thickening or inflammatory changes on imaging, space occupying lesions, persistent vomiting, weight loss, and malabsorption syndromes. Most of the procedures were conducted in the endoscopy suite while 9.8% (n = 6) required the operation room due to patient comorbidities or being in conjunction with a surgical procedure. The majority of the procedures were carried under monitored anesthesia care (93.4%) while the rest were done under general anesthesia. Most procedures were diagnostic (91.8%) and completed without complications (95.1%). The depth of examination ranged from 95 cm to 500 cm with a mean of 282.05 ± 90.04 cm. The most common enteroscopy findings were inflammation and ulcerations (29.5%), followed by masses (19.7%) and vascular malformations (14.8%). Biopsy samples were taken in 33 of the cases and the most common biopsy finding was non-specific inflammation (63.6%). As a result of the findings, a new diagnosis was made in 47.5% of the cases and a previous one was ruled out in 24.6% of them; 65.6% of the cases had a change in management.
Through our study findings, we concluded that SBE is a useful method in diagnosing small bowel problems with a good yield. It is also relatively safe and has a low risk of complications.
More research needs to be conducted on the usage and yields from SBE procedures in low-middle income countries with larger samples. There also needs to be a standardized method to record the details of enteroscopy procedures.