Prospective Evaluation of Push-and-Pull Enteroscopy in Patients with Small Bowel Disorders

Abstract

Background: The largest prospective study on the safety and efficacy of the new method of push-and-pull enteroscopy using a double-balloon technique (PPE) is presented. Methods: Between March 2003 and November 2004, 248 push-and-pull enteroscopies with double-balloon technique (Fuji EN 450P5/20, Fujinon Inc. Japan) were performed in 137 patients with suspected or known small-bowel disease. The patients (77 men, 60 women; mean age 57 ± 18 years) had been suffering from chronic or acute intestinal bleeding (n = 90), abdominal pain (n = 11), polyposis syndromes (n = 14), known Crohn's disease (n = 7), intestinal obstruction induced by swallowed dentures or capsule (n = 3) and others (n = 12). Results: PPE was carried out under sedoanalgesic medication using the oral approach in 50/137 (36%), the anal approach in 7/137 (5%) or both in 80/137 (59%) patients. On an average 240 ± 100 cm (40–550) small bowel had been visualized using the oral route and 140 ± 90 cm (5-350) using the anal route. The total diagnostic yield was 79.5% (109/137): in 34.5% a new diagnosis was found; in 30.5 % the prior diagnosis was confirmed; in 10% a suspected diagnosis could be excluded, in 12% the extent of a known disease was determined and in 18% no relevant finding was diagnosed. In 104/137 (76%) the further treatment was influenced by the results of PPE: an endoscopic therapy was performed in 57/137 patients (42%), medical treatment was given in 23/137 patients (16.5%) and a surgical intervention was done in 24/137 patients (17.5%). In 13/137 patients (9%) other consequences followed; only in 21/137 patients (15%) no further measures were taken (“wait & see”). The enteroscopy system was easy to handle in all cases. No complications such as perforation or bleeding occurred. Conclusions: This new push-and-pull enteroscopy system is easy to handle and safe. Visualization of the whole small bowel is possible. Enteroscopy with the double-balloon technique promises to become the standard method for diagnostic and therapeutic endoscopy of the small bowel without surgical laparotomy.