Double-Balloon Endoscopy for the Treatment of Small Intestinal Diseases

Abstract

Background and Aims: Endoscopic observation and treatment of the small bowel has been limited by its inaccessibility. Double-balloon endoscopy (DBE) (Fujinon Co., Ltd., Saitama, Japan) enables endoscopic scrutiny and treatment of the entire small bowel; with intervention capabilities that allow for targeted biopsies, electrocoagulation, clip placement, endoscopic polypectomy, balloon dilatation, stent placement, and the retrieval of foreign bodies. This method allows for timely endoscopic treatment of disorders heretofore requiring surgical intervention. In this study we evaluated the efficacy of the DBE system for the endoscopic treatment of diverse diseases of the small bowel. Results: A total of 130 patients underwent 200 DBE examinations; between Jun 2003 and Nov 2005 at Nippon Medical School Hospital, Tokyo, Japan. The median age was 57.6 (19-82) years. In all, 20 patients were successfully treated in the process of endoscopic examination. Electrocoagulation or clipping for hemostasis at the bleeding source in the small bowel was conducted in 13 patients (7 angiodysplasias, 4 gastrointestinal stromal tumors, 1 malignant lymphoma and 1 inflammatory fibroid polyp). Regarding gastrointestinal strictures, endoscopic balloon dilatation was performed in 3 patients (delayed stenosis following abdominal blunt trauma, NSAID-induced membranous strictures, circumferential stenosis with malignant lymphoma), and in one patient, a detachable balloon was safely placed across the stricture (anastomotic stricture after Roux-en-Y anastomosis). To avoid perforation, concatenation of the muscle layer was confirmed by endoscopic ultrasound prior to endoscopic dilatation. The DBE could then easily pass through the lesion after dilatation, and clinical symptoms of ileus improved in all patients. A foreign body (a video capsule endoscope) trapped by ileal stenosis in a patient with Crohn's disease was successfully retrieved with net forceps in two patients. Endoscopic polypectomy was performed in one patient. The extent of these lesions ranged over the whole small intestine. All these treatments were beyond the capability of the conventional scope, but were made possible by this innovative system, which greatly improved access to previously inaccessible areas of the small intestine. We encountered no complications during and after any of the procedures performed. Conclusions: DBE is being proven to be a safe and valuable method, with high diagnostic yield offering a wide range of therapeutic capabilities. Our results suggest that DBE can dramatically increase the range of endoscopic treatment and may in certain cases preclude unnecessary surgical intervention.