Polypectomy During Double-Balloon Endoscopy in the Small Bowel: Feasibility and Safety

Abstract

Introduction: Double-balloon endoscopy (DBE) allows visualization of the complete small bowel. Additionally, therapeutic interventions throughout the small bowel can be performed. Recent studies have reported that interventions during DBE can be performed relatively safely. Polypectomy seems to be the intervention associated with the largest risk of complications, which occurred in up to 10,8% of resected polyps. The purpose of this study was to evaluate the feasibility and safety of polypectomy performed during DBE. Materials & Methods: Between November 2003 and May 2007, 603 DBE procedures were performed in an outpatient setting. All procedures in which one or more polypectomies were performed were included in this analysis. Polypectomies were performed using an electrosurgical unit (Erbe, Tübingen, Germany) and polypectomy snares (Medi-Globe, Achenmühle, Germany). If polypectomy was planned, the Fujinon EN-P450 endoscope was used with the Fujinon EN-T450 overtube, to enable re-insertion of the endoscope after resected polyps were retrieved for pathological examination. Results: Polyps were objectified in 38 DBE procedures (6,3%). Polypectomy was performed during 26 procedures in 15 patients. A total of 104 polyps were resected. In 9 procedures a single polypectomy, and 17 procedures multiple polypectomies were performed. Complications occurred in 6 procedures (23.1%) in which polypectomy was performed. Two complications (7.7%) were definitively related to the intervention: One patient had to undergo emergency surgery after polypectomy-related small bowel perforation, and one patient was admitted due to bleeding after polypectomy. Four patients (15.4%) suffered from non-polypectomy related complications: One patient with Gardner's syndrome developed a severe trismus during the procedure, and one patient developed mild acute pancreatitis. Two patients were admitted due to self-limiting abdominal pain of unknown origin. Except for the patient undergoing emergency surgery, all patients were treated conservatively and discharged within 36 hours. None of the complications were lethal. The complication rate per resected polyp was 2%. Discussion: Polypectomy in the small bowel using the DBE-system is a relatively save procedure, allowing endoscopic management of polyposis syndromes and probably reducing the need for abdominal surgery in these kind of patients. Long term follow-up data are warranted to definitively determine the impact of small bowel polypectomies.