Use of the Double-Balloon Enteroscopy System for Colonoscopy in Patients with a Previous Incomplete Examination

Abstract

Background: Colonoscopy is the gold standard for large-bowel diagnostic and therapy. But even experienced endoscopists may fail to complete colonoscopy because of fixation and angulation of the sigmoid colon. The double-balloon enteroscope is a more flexible, smaller-diameter and longer instrument than a standard colonoscope and therefore may provide advantages in fixed angulated colons. Methods: In 10 patients out of 1306 examined in our institution between January and November 2006 colonoscopy with a conventional colonoscope was incomplete because of marked angulations in the sigmoid colon preventing the visualisation of the lumen. In these 10 patients the examination was repeated with a double-balloon enteroscopy system (Fujinon EN-450 P5/20) consisting of an endoscope with a working length of 200 cm and an outer diameter of 8.5 mm and a flexible overtube with a length of 145 cm and an outer diameter of 12 mm. In difference to the configuration used for the small bowel examination no latex balloon was attached at the tip of the enteroscope. The results were evaluated retrospectively. Results: In all 10 patients the caecum could be intubated. The mean time needed to reach the caecum was 15.1 ± 6.5 min. No complications occurred. Previously undiagnosed findings were obtained in 5 cases: 1-3 polyps were found in 3 patients; peridiverticulitis was seen in 2 patients. All polyps were removed endoscopically, histopathology showed adenomas (low-grade dysplasia). In one of the patients multiple large polyps were located in the proximal colon. In this case retrieving of the polyps after resection was performed by extraction of the enteroscope together with the polyp fixed in a snare through the obertube. The overtube remained in its position facilitating the redeployment of the enteroscope. Conclusion: The smaller diameter and the higher flexibility of the enteroscope in comparison with standard colonoscopes are substantial advantages for the passage through angulations of the colon. The drawback of the use of highly flexible endoscopes for colonoscopy is excessive looping. This disadvantage is reduced by the use of the overtube which is a regular component of the double-balloon enteroscopy system. Because this overtube is shorter than the enteroscope its stiffness prevents looping in the distal colon without impairment of the flexibility in the bending section of the enteroscope. Our results suggest that the double-balloon enteroscopy system may enable endoscopists to perform complete colonoscopies in patients in whom the examination using a conventional colonoscope had failed previously because of marked angulations of the sigmoid colon.