PTH-022 Single balloon enteroscopy: initial experience from a UK tertiary centre

Abstract

Introduction Single balloon enteroscopy (SBE) potentially allows assessment of the entire small bowel with the possibility for therapeutic intervention. Preliminary data suggest that this may be better tolerated than double balloon enteroscopy.1 There is limited UK experience of this novel endoscopic technique and we report the initial outcomes from our unit. Aim To assess the indications, diagnostic and therapeutic yield, tolerance and complications of SBE performed within a single tertiary unit. Methods A prospective database is maintained at our unit. We reviewed the database entries and case notes of all patients who underwent SBE over a 24-month period. Comfort and sedations scores are recorded by the nursing staff. Comfort; 1=no discomfort/unable to remember, 2=slightly uncomfortable, 3=uncomfortable but tolerable 4=brief periods of significant discomfort, 5=unacceptable. Sedation; 1=excellent, 2=good, 3=poor. Results Video capsule endoscopy was performed in all patients before SBE. Thirty-seven SBE procedures were performed on 26 patients (20 males), mean age; 64 (range 29–83). Indications were: Iron deficiency anaemia (4), obscure gastrointestinal (GI) bleeding (18), suspected Crohn9s disease (2), abnormal radiology (2), abnormal video-capsule endoscopy findings (10). Thirty-two were antegrade and five were retrograde procedures. 16 (42%) procedures were therapeutic. Histological biopsies were taken in 6 (17%). Two patients required general anaesthesia (1 had a previously failed SBE). Mean sedation doses were midazolam: 4.8 mg (range 2.5–10), fentanyl 85.7 μg (range 50–100). Mean comfort score=2 (range 2–5), mean sedation score 2 (range 2–3). Overall diagnostic yield was 61%. Diagnoses: Angiodysplasia n=10, normal n=15, ulceration n=7, Crohn9s disease n=1, Other n=5. Complications: none. Conclusion Our experience demonstrates that the majority of patients can tolerate SBE under conscious sedation with acceptable comfort and sedation scores. SBE appears to be a safe procedure in all age groups. It has a high diagnostic yield and is a useful modality for therapeutic intervention particularly in obscure GI bleeding.