Jejunal diverticulosis: a limiting condition to double-balloon enteroscopy

Abstract

To the Editor: We recently had the opportunity to read the case report by Kamal and Gerson.1Kamal A. Gerson L. Jejunal diverticulosis diagnosed by double-balloon enteroscopy.Gastrointest Endosc. 2006; 63: 864Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar The authors described an interesting case of jejunal diverticulosis diagnosed by double-balloon enteroscopy (DBE). Small intestinal diverticulosis is a rare condition and most cases are asymptomatic. Symptomatic diverticula have either acute or chronic manifestations. Acute complications include diverticulitis, abscess, perforation, intestinal obstruction, and massive GI bleeding. Chronic complications include malabsorption, chronic abdominal pain, intestinal pseudo-obstruction, and chronic gastrointestinal bleeding. We recently encountered 2 cases with obscure gastrointestinal bleeding and jejunal diverticulosis that were diagnosed after DBE. Although the authors were able to perform DBE to the proximal ileum successfully, we found that DBE is limited in this situation. First, we encountered areas of luminal stenosis resulting from prior diverticulitis in one of the cases. We are concerned about the safety of DBE in passing these areas. The pressure that the inflated balloon exerts on the intestinal mucosa might be uneven in the stenotic and nonstenotic areas. Thus, DBE might lead to increased risk of mucosal injury or even intestinal perforation. Second, DBE failed in another case as a result of adhesion of the bowel loops. The patient had no prior history of abdominal surgery. The most likely explanation for the adhesion is prior episodes of diverticulitis. Given these considerations, we suggest that jejunal diverticulosis is probably a limiting condition to DBE. A carefully performed small bowel series or CT is usually diagnostic. DBE should be reserved for evaluating bleeding complications of jejunal diverticulosis. Jejunal diverticulosis diagnosed by double-balloon enteroscopyGastrointestinal EndoscopyVol. 63Issue 6PreviewA 51-year-old man complained of multiple episodes of acute abdominal pain over the past 4 years. Each episode lasted for 2 to 3 days, and the patient was pain-free between episodes. During one attack, the patient presented with fever and leukocytosis, and free air was demonstrated on an abdominal CT; he improved with conservative treatment, which consisted of antibiotics and bowel rest. Investigations, including upper endoscopy, colonoscopy, and abdominopelvic CT, were unrevealing. Wireless capsule endoscopy revealed multiple positive “red detector” signals, with corresponding mucosal erosions in the jejunum. Full-Text PDF