Double Balloon Enteroscopy: Virginia Commonwealth University Health System Experience

Abstract

Purpose: Review the initial experience with a double-balloon enteroscopy at VCUHS. Methods: This was a retrospective review of the first 100 DBE procedures performed at our center between August 2004 and June 2007 using the Fujinon EN-405T5. Results: 100 DBE procedures were performed on 86 patients. 83 DBE were antegrade (per-oral) and 17 retrograde (per-anal). 85 DBEs were performed using conscious sedation and 15 were done under general anesthesia. The most common indication was obscure GI bleeding (overt and occult) as seen in 88% of patients. Other indications included abdominal pain (5%), tumor/polyps (5%), and retained capsule (2%). Mean procedure time 83 minutes (range 25–210). The first 37 DBEs were performed with fluoroscopy. The remaining DBEs were done without fluoroscopy. Complete enteroscopy was not possible in all patients despite a combined antegrade and retrograde approach. In 8 patients the procedure could not be completed (6 due to inability to tolerate the conscious sedation and 2 due to inability to advance the scope through the ileocecal valve for a retrograde DBE). There were no major complications. All patients were discharged from the endoscopy suite after a 2 hour recovery period. Findings were seen in 61% of the DBEs performed. In 39% of the cases the DBE exam was normal. Of those with positive findings (N = 61) AVM were seen in 63%, erosions or ulcers seen in 13%, Dieulafoy lesions in 4%, polyps in 2%. One patient had a stricture and ulceration; biopsies demonstrated lymphoma. No other case of malignancy was found. In 40% APC treatment was performed. Biopsies were performed in 12% of all DBE, clip and injection in 5%, dilation of a stricture done in 1%. Tattooing to help locate a lesion in the small intestine for laparoscopic treatment was performed in 2%. Tattooing to mark the most distal part of the small intestine reached, was performed in 79% of cases. Conclusion: DBE is safe and provides positive findings in the majority of the cases. AVM is the most commonly found lesions. Therapeutic applications can be frequently performed (APC, biopsies, injection, clip, dilation and tattooing). While time consuming, this technique allows the diagnosis and treatment of lesions in the small bowel. In few cases despite combined antegrade and retrograde attempt to examine the entire length of the small bowel, this was unsuccessful.