Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2024; 16(4): 1043-1054
Published online Apr 27, 2024. doi: 10.4240/wjgs.v16.i4.1043
Single-center retrospective study of the diagnostic value of double-balloon enteroscopy in Meckel’s diverticulum with bleeding
Tian He, Chao Yang, Jing Wang, Ji-Sheng Zhong, Ai-Hua Li, Ya-Jing Yin, Li-Ling Luo, Chun-Mei Rao, Nian-Fen Mao, Qiang Guo, Zan Zuo, Wen Zhang, Ping Wan
Tian He, Chao Yang, Ai-Hua Li, Li-Ling Luo, Qiang Guo, Zan Zuo, Wen Zhang, Ping Wan, Yunnan Digestive Endoscopy Clinical Medical Center, Department of Gastroenterology, The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan Province, China
Jing Wang, Nian-Fen Mao, Department of Medicine, Kunming University of Science and Technology, Kunming 650093, Yunnan Province, China
Ji-Sheng Zhong, School of Medicine, Yunnan University of Traditional Chinese Medicine, Kunming 650011, Yunnan Province, China
Ya-Jing Yin, Department of Gastroenterology, Qujing Hospital of Traditional Chinese Medicine, Qujing 655000, Yunnan Province, China
Chun-Mei Rao, Department of Gastroenterology, Yunnan University of Traditional Chinese Medicine, Kunming 650011, Yunnan Province, China
Co-first authors: Tian He and Chao Yang.
Co-corresponding authors: Ping Wan and Wen Zhang.
Author contributions: Wan P and Guo Q conceived and refined the study; He T and Yang C designed and implemented the study; Wan P, Zhang W, and Zuo Z sponsored the study; Zhong JS and Yin YJ were involved in the data collection; Rao CM and Mao NF were involved in the declaration of institutional review board; Yang C, Li AH, and Luo LL analyzed the data; He T and Wang J drafted the manuscript; Yang C and Zhang W revised the manuscript; all authors were involved in the critical review of the results and contributed to, read, and approved the final manuscript. He T and Yang C contributed equally to this work as co-first authors because both of them were in charge of study execution and manuscript writing; Wan P and Zhang W contributed equally to this work as co-corresponding authors; Zhang W had experience in manuscript writing and publication, made great effort in revising and submitting the manuscript, as well as sponsoring the study; Wan P was the main corresponding author and took primary responsibility for communication with the journal during manuscript submission, peer-review, and the publication processes.
Supported by the Ten Thousand Doctor Plan in Yunnan Province, No. YNWR-MY-2018-020; Yunnan Digestive Endoscopy Clinical Medical Center Foundation for Health Commission of Yunnan Province, No. 2021LCZXXF-XH07, No. 2021LCZXXF-XH15, and No. 2022LCZXKF-XH17; and Yunnan Provincial Key Laboratory of Clinical Virology, No. 202205AG070053-07.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the First People’s Hospital of Yunnan Province (Approval No. KHLL2023-KY119).
Informed consent statement: All study participants or their legal guardians, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: All involved participants (subjects or legally authorized representative) gave their informed consent (written or verbal, as appropriate) prior to study inclusion. Study information and statistical methods are available for sharing from the corresponding author at KMWP_66@126.com or 309771477@qq.com.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accord with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ping Wan, MD, Doctor, Department of Gastroenterology, The First People’s Hospital of Yunnan Province, No. 157 Jinbi Road, Xishan District, Kunming 650032, Yunnan Province, China. 309771477@qq.com
Received: October 26, 2023
Peer-review started: October 26, 2023
First decision: December 7, 2023
Revised: January 2, 2024
Accepted: January 29, 2024
Article in press: January 29, 2024
Published online: April 27, 2024
Abstract
BACKGROUND

The study aimed to analyze the characteristic clinical manifestations of patients with intestinal disease Meckel’s diverticulum (MD) complicated by digestive tract hemorrhage. Moreover, we aimed to evaluate the value of double-balloon enteroscopy (DBE) in MD diagnosis and the prognosis after laparoscopic diverticula resection.

AIM

To evaluate the value of DBE in the diagnosis and the prognosis after laparoscopic diverticula resection for MD with bleeding.

METHODS

The study retrospectively analyzed relevant data from 84 MD patients treated between January 2015 and March 2022 and recorded their clinical manifestations, auxiliary examination, and follow-up after laparoscopic resection of diverticula.

RESULTS

(1) Among 84 MD patients complicated with hemorrhage, 77 were male, and 7 were female with an average age of 31.31 ± 10.75 years. The incidence was higher in men than in women of different ages; (2) Among the 84 MD patients, 65 (78.40%) had defecated dark red stools, and 50 (58.80%) had no accompanying symptoms during bleeding, indicating that most MD bleeding appeared a dark red stool without accompanying symptoms; (3) The shock index of 71 patients (85.20%) was < 1, suggesting that the blood loss of most MD patients was less than 20%–30%, and only a few patients had a blood loss of > 30%; (4) The DBE-positive rate was 100% (54/54), 99mTc-pertechnetate-positive scanning rate was 78% (35/45) compared with capsule endoscopy (36%) and small intestine computed tomography (19%). These results suggest that DBE and 99mTc-pertechnetate scans had significant advantages in diagnosing MD and bleeding, especially DBE was a highly precise examination method in MD diagnosis; (5) A total of 54 MD patients with hemorrhage underwent DBE examination before surgery. DBE endoscopy revealed many mucosal manifestations including normal appearance, inflammatory changes, ulcerative changes, diverticulum inversion, and nodular hyperplasia, with ulcerative changes being the most common (53.70%). This suggests that diverticular mucosal ulcer was the main cause of MD and bleeding; and (6) Laparoscopic dissection of diverticulae was performed in 76 patients, The patients who underwent postoperative follow-up did not experience any further bleeding. Additionally, follow-up examination of the 8 cases who had declined surgery revealed that 3 of them experienced a recurrence of digestive tract bleeding. These findings indicate that laparoscopic diverticula resection in MD patients complicated by bleeding had a favorable prognosis.

CONCLUSION

Bleeding associated with MD was predominantly observed in male adolescents, particularly at a young age. DBE was a highly precise examination method in MD diagnosis. Laparoscopic diverticula resection effectively prevented MD bleeding and had a good prognosis.

Keywords: Meckel’s diverticulum with bleeding, Double-balloon colonoscopy, 99mTc-pertechnetate scanning, Capsule endoscopy, Ectopic gastric mucosa

Core Tip: Our study aimed to analyze the characteristic clinical manifestations of patients with intestinal disease Meckel’s diverticulum (MD) complicated by digestive tract hemorrhage. Our study found that MD tends to occur in young men, and double-balloon enteroscopy has a high diagnostic value for MD. The main endoscopic manifestation of MD accompanied by bleeding was ulcer, and gastric/pancreatic mucosal ectopia was the main pathological factor causing ulcer.