Clinical Features of Small Bowel Diverticula Diagnosed by Double Balloon Enteroscopy

Abstract

Purpose: Diverticulosis of the large bowel is a common, well described disorder. Due to difficulties in diagnosis and a relatively low prevalence, the clinical features of diverticulosis of the small bowel are less well understood. In autopsy studies, small bowel diverticula have been found in up to 10% of patients. They are not easily diagnosed with cross sectional abdominal imaging or even video capsule endoscopy (VCE). The increasing use of deep enteroscopy to evaluate the small bowel has improved our ability to diagnose and characterize this underappreciated abnormality. In this retrospective review, we describe the clinical features of small bowel diverticula seen at double balloon enteroscopy (DBE). Methods: We retrospectively reviewed the endoscopy reports of 237 patients who underwent outpatient or inpatient DBE at our institution from January 2008 to December 2010. All procedures were performed by one experienced endoscopist with the assistance of GI fellows and endoscopy technicians. DBE was performed using the Fujinon EN-450T5 double balloon enteroscope (Fujinon Inc, Saitama City, Japan). Diverticula were noted to be single or multiple and their location was based on the route of DBE and depth of insertion. Results: All DBE's were performed to evaluate obscure GI bleeding and/or abnormal VCE findings. 8 patients underwent both antegrade and retrograde DBE, 5 antegrade alone and 3 retrograde alone. A total of 16/237 (7%) patients, 9 males and 7 females with a mean age of 75 (range 39 to 89) were found to have small bowel diverticulosis. In 4 patients with obscure bleeding, diverticulosis was the only abnormality. Only 1 patient had evidence of bleeding with a visible clot. 56% (9/16) of diverticula were found in the jejunum, 44% (7/16) in the ileum and 1 in the duodenum. One patient had both jejunal and ileal diverticula. Multiple diverticula were found in 44% (4/9) of patients with jejunal and 29% of patients with ileal diverticula. Only one patient had a Meckel's diverticulum. Conclusion: Small bowel diverticula are readily identified in patients undergoing Double Balloon Enteroscopy and can be a cause of obscure gastrointestinal bleeding. Patients tend to be elderly. They are found in both the proximal and distal small bowel. Multiple diverticula were seen more frequently in the jejunum. In this series, duodenal and Meckel's diverticula were infrequently found.