Prospective Trial Comparing Push-Enteroscopy and Push-and-Pull Enteroscopy Using Double-Balloon Technique in Patients with Small Bowel Diseases

Abstract

Background: Push enteroscopy (PE) is currently the “gold standard” of conventional small bowel enteroscopy. However, penetration depths of PE is limited. The new method of push-and-pull enteroscopy using a double-balloon technique (PPE) makes total enteroscopy possible.This prospective trial compared both methods with the regard to investigation time, insertion depths, x-ray exposure, amount of sedoanalgetic medication, diagnostic yield as well as complications. Methods: Between November 2003 and November 2004 fifty patients (32 men, 18 women with a mean age of 57 ± 18 years) with suspected or known disease of the small bowel were enrolled in this prospective study. All patients underwent first push enteroscopy (Fuji EN 410 WM, Fujinon Inc. Japan) and then PPE (Fuji EN 450P5/20, Fujinon Inc. Japan). The majority of patients (38/50, 76%) suffered from chronic or acute intestinal bleeding. Results: All enteroscopies were done without complications. The amount of sedoanalgetic medication was not statistically significant using midazolam, meperidine and valium, using propofol there was a siginificant higher dosage given during PPE (p = 0.003). There is a statistically significant difference between both methods regarding investigation time (PE 21 ± 12 min vs. PPE 70 ± 30 min, p ≤ 0,001); x-ray exposure (median PE 0.65 min. vs. PPE 1.9 min., p ≤ 0.001; PE 68 dGy/cm2 vs. PPE 160 dGy/cm2, p = 0.007) as well as insertion depths (median PE 80 cm post pyloric vs. PPE 210 cm post pyloric, p ≤ 0,001). The diagnostic yield of PPE is significantly higher than with PE (78% vs. 42%, p ≤ 0.001). Conclusions: The prospective comparison proves that PPE is significant superior to PE with respect to insertion depths and diagnostic yield and should become the method of choice in patients where a deep as possible enteroscopy is required. Background: Push enteroscopy (PE) is currently the “gold standard” of conventional small bowel enteroscopy. However, penetration depths of PE is limited. The new method of push-and-pull enteroscopy using a double-balloon technique (PPE) makes total enteroscopy possible.This prospective trial compared both methods with the regard to investigation time, insertion depths, x-ray exposure, amount of sedoanalgetic medication, diagnostic yield as well as complications. Methods: Between November 2003 and November 2004 fifty patients (32 men, 18 women with a mean age of 57 ± 18 years) with suspected or known disease of the small bowel were enrolled in this prospective study. All patients underwent first push enteroscopy (Fuji EN 410 WM, Fujinon Inc. Japan) and then PPE (Fuji EN 450P5/20, Fujinon Inc. Japan). The majority of patients (38/50, 76%) suffered from chronic or acute intestinal bleeding. Results: All enteroscopies were done without complications. The amount of sedoanalgetic medication was not statistically significant using midazolam, meperidine and valium, using propofol there was a siginificant higher dosage given during PPE (p = 0.003). There is a statistically significant difference between both methods regarding investigation time (PE 21 ± 12 min vs. PPE 70 ± 30 min, p ≤ 0,001); x-ray exposure (median PE 0.65 min. vs. PPE 1.9 min., p ≤ 0.001; PE 68 dGy/cm2 vs. PPE 160 dGy/cm2, p = 0.007) as well as insertion depths (median PE 80 cm post pyloric vs. PPE 210 cm post pyloric, p ≤ 0,001). The diagnostic yield of PPE is significantly higher than with PE (78% vs. 42%, p ≤ 0.001). Conclusions: The prospective comparison proves that PPE is significant superior to PE with respect to insertion depths and diagnostic yield and should become the method of choice in patients where a deep as possible enteroscopy is required.