Push and Pull Enteroscopy Using Single-Balloon Enteroscope System: Technique, Feasibility and Preliminary Results

Abstract

Background: The diagnosis and treatment of small bowel diseases have been impeded by the lack of appropriate instruments. Several endoscopic techniques have been developed in recent years, including capsule endoscopy (CE) and double balloon enteroscope. Recently another a new method was also developed: the single-balloon enteroscope (SBE-Olympus, Tokyo, Japan). The SBE system consists of a high-resolution videoendoscope and a flexible overtube. A latex free silicone balloon is attached at the tip of the overtube, and is inflated and deflated with air from a pressure-controlled pump system. The tip of the enteroscope has a broad bending capability due to its extreme flexibility allowing anchorage to the small bowel without balloon. By using these method to grip the intestinal wall, the endoscope can be inserted further without forming redundant loops in the small intestine. Patients and Methods: Between July 2006 and November 2007, 37 SBE procedures (34 oral and 3 anal approaches) were performed under general anesthesia on 34 patients. Starting insertion route (anal or oral) of SBE was chosen according to the estimated location of the suspected lesions based on the clinical presentation and on the findings, when available, of previous investigations such as CE performed in 26 patients. Indications were acute recurrent or chronic gastrointestinal bleeding (N = 18), chronic abdominal pain and /or chronic diarrhea (N = 5), suspected gastrointestinal tumors (N = 3), suspected Crohn's disease (N = 2), suspected refractory celiac disease (N = 2), polyposis syndromes (N = 4): 3 Peutz-Jeghers and 1 Familial Adenomatous Polyposis respectively. Results: In 2 patients the SBE was not carried out for technical problems. A definite bleeding source was found and treated in 16 patients: APC was used in 13 patients with multiple angiodysplasias and in 1 with a bleeding jejunal polyp. In one patient the bleeding source was a capillary hemangioma-angiomatosis of the jejunum, treated with sclerotherapy using polidocanol and in another one a Dieulafoy's lesion treated with APC and epinephrine injection. In patients with Peutz-Jeghers syndrome and FAP multiple resections of small-bowel polyps were carried out. In another 2 cases SBE plus histology led to the diagnosis of idiopathic eosinophilic enteritis and of melanoma metastases, respectively. SBE was diagnostic for celiac disease in one patient and for Gastrointestinal Stromal Tumors and Crohn's disease in 2 cases respectively. No major complication occurred. Conclusions: According to our prelimirary experience, SBE seems to be safe and useful highly effective in the diagnosis and therapy of several small bowel diseases.