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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
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
ARTICLE HIGHLIGHTS
Research background
Due to the lack of specific symptoms and signs of bleeding caused by Meckel’s diverticulum (MD), preoperative diagnosis is difficult, and it is easy to be clinically misdiagnosed or even missed. As double-balloon enteroscopy (DBE) is a highly precise examination method in MD diagnosis, the study aims to analyze the characteristic clinical manifestations of patients with intestinal disease MD complicated with digestive tract hemorrhage; as well as to evaluate the value of DBE in MD diagnosis and the prognosis after laparoscopic diverticula resection.
Research motivation
The study investigated the prevalent population of MD in a retrospective study to guide early screening and preventive treatment for high-risk individuals; explore the causes of bleeding in MD to facilitate early preventive measures, compare the advantages of DBE with other examination methods to assist in the rational formulation of clinical diagnosis and treatment strategies; and evaluating the therapeutic effectiveness of laparoscopic resection of MD and further exploring more optimal treatment approaches.
Research objectives
The study objectives were to analyze the diagnostic value of DBE in patients with MD and bleeding.
Research methods
The study retrospectively analyzed relevant data from 84 MD patients between January 2015 and March 2022 and recorded their clinical manifestations, auxiliary examination, and follow-up after laparoscopic diverticula resection. The clinical data of 84 patients diagnosed with MD and hemorrhage by DBE and other auxiliary examinations (small intestine CT, nuclide scan, and CE) in the past 7 years were retrospectively analyzed. A dual-balloon colonoscopy system (EN-450P5, a diagnostic endoscope, or 450T5, a therapeutic endoscope) was used. Clinical data were collected and analyzed, which included sex, age, bleeding characteristics, blood routine, biochemical indicators, coagulation function test, imaging or endoscopy, postoperative pathological examination, and follow-up results.
Research results
Firstly, MD with bleeding was more common in young men, and was mostly manifested as dark red bloody stool, with less bleeding. Secondly, we combined the endoscopic manifestations with the pathological results of patients with MD complicated by bleeding. It was found that combined ulcer was the main cause of MD bleeding. The formation of ulcer and mucosal layer hyperplasia were related to gastric mucosa/pancreatic tissue, which guided clinicians to be aware of gastric mucosa/pancreatic tissue heterotopic. Thirdly, this study found that DBE and 99mTc-pertechnetate scanning had obvious advantages for the diagnosis of MD complicated with bleeding, and laparoscopic surgical resection for MD complicated with bleeding could obtain a better prognosis, guiding clinicians to make the best choice in diagnosis and treatment.
Research conclusions
This study showed that MD with bleeding was more common in young men, and most patients presented with dark red stool defecation. Following the occurrence of bleeding, the evaluation of the shock index revealed a value significantly less than 1, thus most patients with hemorrhage tolerated DBE examination. DBE was used as the first choice for examination, and laparoscopic diverticulectomy had a good prognosis. The diagnostic and treatment procedures for small intestinal bleeding should be further study to the specific characteristics of the bleeding, anemia, and other relevant parameters.
Research perspectives
The small intestine is currently a blind spot for most examination methods. DBE addresses this gap. At our center, it has been observed that a significant portion of unexplained gastrointestinal bleeding is often associated with small intestine diseases. MD is the most common cause of small intestine bleeding. Clearly defining the diagnostic role of DBE in small intestine diseases is beneficial for formulating rational clinical diagnosis and treatment plans.
