IDDF2018-ABS-0214 Diagnostic yield and therapeutic potential of single balloon enteroscopy in children

Abstract

Background Evaluation of small bowel diseases has been revolutionised with the advent of capsule endoscopy and balloon assisted enteroscopy (BAE). As opposed to capsule endoscopy, BAE enables tissue biopsies and performing therapeutic procedures. BAE is an effective tool for the diagnosis and management of small bowel diseases in adults. However, data is limited in the paediatric population. We aimed to evaluate the diagnostic yield and therapeutic potential of BAE in the paediatric population. Methods The data of all the children under 18 years of age who underwent BAE with single balloon enteroscope (SBE) from August 2011 to December 2017 was analysed for the role of SBE in diagnosis and management of small bowel disease. Results A total of 144 children (mean age 15.09 years; range 4–18 years, boys-96) underwent SBE during the study period. Indications were pain abdomen (n=87), chronic diarrhoea (n=33), obscure gastrointestinal bleeding (OGIB) (n=19) and recurrent vomiting (n=9). Oral enteroscopy was performed in 78 children with a mean insertion length of 183.35±62.51 cms beyond the duodeno-jejunal flexure and mean procedure duration of 40.9±16.08 min. Retrograde enteroscopy was performed in 66 children with a mean insertion length of 125.70±45.24 cms and mean duration of 42.04±10.05 min. Diagnostic yield in children presenting with pain abdomen, chronic diarrhoea, OGIB and vomiting was 41.37%, 44.82%, 57.89% and 22%, respectively. In children with pain abdomen and significant weight loss, the diagnostic yield was 84.21%. Therapeutic procedures were done in 8 children (polypectomy in 5 and argon plasma coagulation in 3), and 11 patients underwent surgery. In addition, four patients underwent intra-operative enteroscopy for OGIB, three underwent small bowel resection, one patient underwent gastro-jejunostomy for duodenal ulcer. No major complications were observed. Conclusions SBE is a safe and effective tool for diagnosis and management of small bowel diseases in children. Pain abdomen was the most common indication for enteroscopy, and diagnostic yield was especially high in patients presenting with pain abdomen and associated significant weight loss.