Initial Description of Technical Aspects of Double Balloon Enteroscopy in a US Population

Abstract

Background: Double balloon enteroscopy (DBE) is a new endoscopic technique, which may enable improved small bowel visualization, diagnosis and therapy. Initially described abroad, little data exist describing technical and logistical use of DBE in a US population. Methods: Patient demographics, DBE indication, performance variables and study complications were reviewed for the first 77 DBE procedures (56 oral, 21 anal) performed on 53 pts between September 2004 and November 2005 at Fox Chase Cancer Center. Results: Mean patient age was 67 years (range 23-86). 24 men and 29 women were studied. Conscious sedation, used in 49/53 patients, was associated with longer stay in unit than MAC/GETA cases (mean 4:37 vs. 3:44). Indications included: obscure GI bleeding (36), post-Whipple stent removal (6), abnormal xray or capsule endoscopy unrelated to obscure GI bleeding (6), small bowel obstruction (4), and abdominal pain (1). Most patients (35) underwent a single DBE (oral or anal); 13 underwent two DBE, and 5 underwent three DBE. Performance variables are reported below (see table). Complete enteroscopy was accomplished in 7 of 19 patients undergoing bidirectional DBE, but in none studied unidirectionally. Interventions (successes / attempts) included: biopsies (14/14), hemostasis for active bleeding (4/5), polypectomy (2/2), post-Whipple stent retrieval (3/6), and APC (17/17). Looping or angulation often prevented further advances (in 51.7% oral, 90.5% anal DBE) and contributed to unsuccessful ileal intubation (in 23.8% anal DBE). Prior abdominal surgery resulted in a trend toward shorter distances traversed (mean 131.2 vs 150.2 cm, p = NS). Eleven complications occurred: moderate mucosal trauma (3), post-biopsy or post-tattoo injection bleeding controlled endoscopically (2), a sublingual hematoma (1), mild to moderate oral bleeding (2), sedation-induced hypoxia (2), and arrhythmia (1). All were managed conservatively with no sequelae. Conclusions: DBE is a feasible option for small bowel diagnosis and therapy with an acceptable safety profile. It is associated with longer procedure-related time and length of stay in the endoscopy unit compared to other endoscopic procedures. Additional studies are required to define its clinical utility. Tabled 1 Variable Approach Average ± SD Median Range Total Procedure Time (min) Oral: Anal: 81.6 ± 27.0 87.6 ± 25.8 82.0 86.5 14-155 38-145 Insertion Time (min) Oral: Anal: 61.8 ± 27.3 65.9 ± 21.3 65.6 66.0 7-130 27-100 Distance (cm, excludes Whipples/BII) Oral: Anal: 188 ± 70.4 58.7 ± 54.4 185.0 45.0 70-355 0-220 Fluoroscopy Time (min) Oral+Anal 6.4 ± 0.4 5.21 0.2-21.9 Total Time in Endoscopy Unit (hr:min) Oral+Anal 4:34 4:28 1:52-7:15 Open table in a new tab