Usefulness of Double-Balloon Enteroscopy (DBE) for Diagnosis and Treatment of Small Intestinal Diseases

Abstract

Background: DBE has enabled endoscopic scrutiny, tissue sampling and interventional therapies of the entire small intestine from combined oral and anal approaches. We evaluated the usefulness of this enteroscopy. Patients and Methods: Fifty patients (pts) with obscure gastrointestinal bleeding (OGIB), 24 pts with ileus, 14 pts with tumors or polyps in the small intestine, 7 pts with abdominal pain, and 5 pts with chronic diarrhea of unknown origin have undergone this enteroscopy between June 2003 and December 2004 (62 oral and 105 anal approaches). Results: Of 50 pts with OGIB, angiodysplasia (n = 14; treated by electrical cauterization including argon plasma coagulation and heat probe), drug-induced ulcer (n = 4, including NSAID enteropathy), simple ulcer (n = 4), radiation-induced injury (n = 3), diverticulei (n = 3, including Meckel's diverticulum), ulcer in the distal duodenum (n = 3), one ileal Dieulafoy's ulcer (treated by clipping), one carcinoid, and one Crohn's disease were diagnosed. Of 24 pts with ileus, Crohn's disease (n = 11, 5 pts treated by enteroscopic through-the-scope balloon dilatation without complications and 3 pts treated by surgery), ischemic enteritis (n = 3), chronic intestinal pseudoobstruction (n = 3), post-operative adhesion (n = 2), one multiple NSAID-induced membranous strictures (treated by enteroscopic through-the-scope balloon dilatation without complications), one malignant lymphoma (ML), one multiple carcinoid, one ileal metastasis of lung adenocarcinoma, and one intestinal anisakiasis were diagnosed. Of 14 pts with small intestinal tumors or polyps, ML (n = 4), adenomatous polyps (n = 4, 3 with familial adenomatous polyposis, one ileal 7-mm flat adenoma treated by EMR), Peutz-Jeghers polyps (n = 3, 2 with complete type and 1 with incomplete type, all polyps ranging from 10-60 mm in size treated by polypectomy), one carcinoid, one multiple gastrointestinal stromal tumor, and one jejunal metastasis of malignant melanoma were diagnosed. Enteroscopic resection was achieved without severe complications. Of 7 pts with abdominal pain, post-operative (n = 2) and post-pancreatitis (n = 1) adhesions were diagnosed. Of 5 pts with chronic diarrhea, amyloidosis (n = 1) was diagnosed. Conclusion: DBE was useful for diagnosis and treatment of small intestinal diseases such as bleeding, ileus, tumors and polyps. The long-term effects of enteroscopic balloon dilatation of Crohn's disease strictures should be further analyzed. Background: DBE has enabled endoscopic scrutiny, tissue sampling and interventional therapies of the entire small intestine from combined oral and anal approaches. We evaluated the usefulness of this enteroscopy. Patients and Methods: Fifty patients (pts) with obscure gastrointestinal bleeding (OGIB), 24 pts with ileus, 14 pts with tumors or polyps in the small intestine, 7 pts with abdominal pain, and 5 pts with chronic diarrhea of unknown origin have undergone this enteroscopy between June 2003 and December 2004 (62 oral and 105 anal approaches). Results: Of 50 pts with OGIB, angiodysplasia (n = 14; treated by electrical cauterization including argon plasma coagulation and heat probe), drug-induced ulcer (n = 4, including NSAID enteropathy), simple ulcer (n = 4), radiation-induced injury (n = 3), diverticulei (n = 3, including Meckel's diverticulum), ulcer in the distal duodenum (n = 3), one ileal Dieulafoy's ulcer (treated by clipping), one carcinoid, and one Crohn's disease were diagnosed. Of 24 pts with ileus, Crohn's disease (n = 11, 5 pts treated by enteroscopic through-the-scope balloon dilatation without complications and 3 pts treated by surgery), ischemic enteritis (n = 3), chronic intestinal pseudoobstruction (n = 3), post-operative adhesion (n = 2), one multiple NSAID-induced membranous strictures (treated by enteroscopic through-the-scope balloon dilatation without complications), one malignant lymphoma (ML), one multiple carcinoid, one ileal metastasis of lung adenocarcinoma, and one intestinal anisakiasis were diagnosed. Of 14 pts with small intestinal tumors or polyps, ML (n = 4), adenomatous polyps (n = 4, 3 with familial adenomatous polyposis, one ileal 7-mm flat adenoma treated by EMR), Peutz-Jeghers polyps (n = 3, 2 with complete type and 1 with incomplete type, all polyps ranging from 10-60 mm in size treated by polypectomy), one carcinoid, one multiple gastrointestinal stromal tumor, and one jejunal metastasis of malignant melanoma were diagnosed. Enteroscopic resection was achieved without severe complications. Of 7 pts with abdominal pain, post-operative (n = 2) and post-pancreatitis (n = 1) adhesions were diagnosed. Of 5 pts with chronic diarrhea, amyloidosis (n = 1) was diagnosed. Conclusion: DBE was useful for diagnosis and treatment of small intestinal diseases such as bleeding, ileus, tumors and polyps. The long-term effects of enteroscopic balloon dilatation of Crohn's disease strictures should be further analyzed.