Diagnostic Yield and Therapeutic Impact of Single Balloon Enteroscopy; A Series of 60 Patients with Suspected Small Bowel Disease

Abstract

Introduction: Non surgical management of small intestinal diseases is difficult due to lack of proper instruments to access the long redundant bowel loops. Single balloon enteroscopy (SBE) is novel method of push and pull enteroscopy which allows deep intubation of intestine. Aim: Single-center prospective study conducted from February 2007 to October 2007, to evaluate the clinical utility of the prototype SBE system. Methods: Subjects with suspected small bowel disease who required deep enteroscopy were enrolled. The Olympus XSIF-Q260Y enteroscope [200 cm length,9.2 mm outer diameter (OD), and 2.8 mm working channel] was coupled with a 132 cm long,13.2 mm OD single use silicon overtube, which has a balloon at the distal end. Balloon is operated with Olympus balloon control unit (MAJ 1440). The tip of the enteroscope has a broad bending capability due to its extreme flexibility allowing anchorage to the small bowel thus facilitating deep intubation. Depth of insertion was determined by carefully recording length of the scope inserted during each pull and push maneuver. Fluoroscopy was utilized intermittently. Enteroscopy was done under monitored anesthesia care (Midazolam, Propofol). All patients underwent antegrade enteroscopic examination, 10 underwent both antegrade and retrograde procedures, with tattooing during the initial procedure to confirm a total small-bowel examination. Results: A total of 60 subjects (36M /24F, mean age 39.83 ± 14.66 Years) were studied. Indications for SBE included obscure GI bleeding(18),chronic abdominal pain with abnormal imaging studies like Barium series, CTscan etc (21), malabsorption Syndrome (11), Polyposis syndromes (9) and Foreign body (1). Mean procedure time was 63 ± 18 min. The mean depth of insertion was 260 ± 60 cms beyond ligament of Treitz. Pan-enteroscopy was possible in 5 out of 10 cases. Enteroscopic findings were arteriovenous malformations [AVMs] (7), ulcers (15), polyps (6), diffuse enteritis (2), mass lesion (3) and effacement of jejunal folds (3). Histological diagnosis included adenocarcinoma (3), Crohn's disease (4), Tuberculosis (2), Strongyloidosis (2), Giardiasis (1), Amyloidosis (1), Celiac Sprue (4), Tropical sprue(1), Hamartomatous polyps (4) and non specific ulcers(9). Diagnostic yield in cases of obscure G I bleed, chronic abdominal pain and malabsorption syndrome were 77%, 61% and 63% respectively. Therapeutic interventions included Argon plasma coagulation of bleeding ulcers and AVMs (12), Polypectomy (3) and foreign body removal (1). No complications were encountered. Conclusion-The Olympus single balloon enteroscope was well-tolerated and led to a high diagnostic and therapeutic yield in cases of small bowel disorders.