Feasibility of Single-Balloon Enteroscopy for Evaluation of the Small Bowel

Abstract

Purpose: The single-balloon enteroscope (SBE) for investigation of the small bowel was introduced very recently. The handling of the device might be simplified by omitting the balloon on the top of the endoscope compared to the double-ballon enteroscope (DBE). In this prospective study we have investigated the handling and the diagnostic and therapeutic opportunities in the small bowel as well as the complications of the SBE. Methods: An enteroscopy was performed in 38 patients with (mean age 62 y, 25 female, 13 male) using the singe-balloon device (SIF-Q180, Olympus, Germany). Overall 53 investigations were performed (41 via oral route, 12 via anal route) in combined midazolam/propofol sedation under fluoroscopic control. Indications were occult GI-bleeding after previous endoscopic evaluation of the upper and lower GI tract (N = 18), IBD (N = 13), suspected malignant disease (N = 3), unclear malabsorption syndrome (N = 4). The push and pull-back of the endoscope is comparable to the DBE. Instead of insufflation of the second balloon at the top of the endoscope, the endoscope is in a stable position fixed by bending behind a fold during the pull-back of the endoscope and the overtube. The deepest point during SBE was marked by submucosal ink injection. Results: Overall a diagnostic and/or therapeutic gain was reached in 22 patients (58%) by SBE. Angiodysplasias were the most common findings, treated immediately with APC. Rare diagnosis like jejunal diverticulitis and primary adenocarcinoma of the jejunum were diagnosed. We have seen cases with segmental inflammation of the jejunum, lymphangiectasia and one pneumatosis. In one case the diagnosis of celiac disease was made on biopsies from jejunum with normal findings in the duodenum. Intubation of the ileum is sometimes difficult, we failed in 3 patients. The mean investigation time was 68 min, we used in the mean 2.5 mg midazolam and 460 mg Propofol (=7 mg/min). In 7 patients significant increase of amylase/lipase was observed, none of them suffered from abdominal pain. Superficial mucosal lacerations have been observed in 4 cases. The preparation time before the investigation is about 15 min less compared to DBE because there is no installation of a second balloon on the top of the endoscope. Conclusion: The single-balloon enteroscope is a highly sufficient device for investigations of the small bowel. Advantages are due to the easier handling and resulting in a reduced need of man power. The diagnostic possibilities should be equal compared to the DBE.