Effect of Procedural Factors On the Success Rate of Complete Double-Balloon Enteroscopy

Abstract

Introduction: Double-balloon enteroscopy (DBE) enables complete endoscopic intubation of the gastrointestinal tract. However, the success rate of complete enteroscopy varies widely in the literature. Aim: We evaluated the effect of procedural factors (type of endoscope and type of sedation) on the success rate of complete DBE in a cohort of 69 patients with suspected small bowel pathology. The study was approved by the local Ethics Committee. Patients: 69 Caucasian patients were referred for DBE for suspected small bowel pathology after former negative conventional upper and lower gastrointestinal endoscopy. All patients signed informed consent and underwent both the antegrade and retrograde approach using either the Fujinon EN-450T5 treatment endoscope or the EN-450P5 pediatric endoscope in an attempt to visualise the entire small bowel. Distal marking of the antegrade approach was either submucosal Indian ink injection or mucosal hemostatic clip application. Most procedures were performed under conscious sedation using midazolam and fentanyl. In 12 patients general anesthesia with propofol and endotracheal tube ventilation was used. Results: Male female ratio was 32/37 with a mean age of 57 ± 2 years ranging from 7 to 85 years. Overall success rate of complete enteroscopy (combination of antegrade and retrograde approach) was 10.2%. The success rate did not depend on the type of sedation: 10.5% with conscious sedation (n = 57) and 8.3% with general anesthesia (n = 12) (Chi-square p = 0.8191). However, the use of the EN-450P5 pediatric endoscope (n = 6) resulted in a significantly higher success rate of 50.0% in comparison with the success rate of 6.4% with the EN-450T5 treatment endoscope (n = 63) (Chi-square p = 0.0007). Reasons for incomplete enteroscopy were positive diagnosis (8.1%), patient's discomfort (17.7%) or technical inability to complete the enteroscopy (74.2%). Conclusions: In this cohort of 69 Caucasian patients who underwent both antegrade and retrograde DBE in an attempt to visualise the entire small bowel, overall success rate was 10.2%, which is in accordance with the majority of the reported numbers in the literature. The success rate was highly dependent upon the use of the EN-450P5 pediatric endoscope over the EN-450T5 treatment endoscope, and independent of the type of sedation used.