Safety and Efficacy of Single Balloon Enteroscopy: A 2 Year Veterans Affairs Medical Center Experience

Abstract

Purpose: Single Balloon Enteroscopy (SBE) is a novel method of push and pull enteroscopy, allowing deep intubation of the small bowel (SB). Long-term outcomes data on utilization and efficacy of this technique have only recently emerged, but data on the utility of SBE in the Veteran's Affairs (VA) population are lacking. Here we evaluate the safety, efficacy and utility of SBE in the VA population. Methods: Forty-seven SBE studies in 39 consecutive patients from a single operator at the Sacramento VA Medical Center between December 2008 and April 2011 were retrospectively reviewed and data of outcome measures including depth of insertion, extent of examination, procedure time, complications, diagnostic yield and related therapeutic or diagnostic interventions were collected. All procedures were performed under moderate conscious sedation. Results: Of the 39 patients reviewed, 36 (92%) were men and 3 (8%) were women. The mean age was 66 +/- 10 years. Twenty-nine (74%) patients were Caucasian, 8 (21%) patients were African-American and 2 (5%) were not reported. Of the 47 studies, the major indications were occult obscure GI bleed (62%), overt obscure GI bleed (13%), abdominal pain (19%), unexplained weight loss (13%), chronic diarrhea (11%) and suspected tumor/mass (6%). Four (9%) studies used the retrograde approach while 43 (91%) used the anterograde approach. The mean ASA score was 2.06 +/- 0.04. Six (13%) cases were done in-patient and 41 (87%) as out-patient. The mean procedure time was 54.7 +/- 2.25 minutes. The mean extent of examination for the retrograde approach was 143.8 +/- 32.9 cm, while that for the anterograde approach was 273.7 +/- 10.3 cm. The overall diagnostic yield was 76.6%. Findings on SBE included angioectasias (44.7%), ulcers (10.6%), NSAID enteritis (8.5%0, erosions (6.4%), evidence of celiac disease (4.3%), tumors (4.3%) and stricture (2.1%). Thirty-three (70%) cases benefited from therapeutic intervention. Diagnostic intervention by mucosal biopsy was utilized in 19 (40%) cases. There were no complications. Conclusion: Small bowel enteroscopy is a safe and well tolerated procedure for the evaluation of SB pathology in VA patients. That complete enteroscopy was not achieved in any of our patients suggests that the greatest utility of SBE may be in further evaluation of previously localized disease. Further studies dedicated to evaluating the efficacy of SBE in this setting would further improve utilization of this technique.