Utility of Double Balloon Enteroscopy in Patients With Surgically Altered Bowel Anatomy After Bariatric Surgery

Abstract

Introduction: To evaluate the diagnostic yield, success and complications rates of double-balloon enteroscopy (DBE) in consecutive patients with GI disorders necessitating endoscopic evaluation. Methods: Single-center, observational, cohort study of consecutive patients with post-obesity surgery undergoing DBE during a 14-month period. Patients’ demographics, procedure indications, findings, endoscopic interventions, and post-procedural recovery data were recorded. Results: A total of 270 DBE were performed at our institution during the study period. Thirty-eight patients (13.3%) with post-obesity surgery were evaluated using DBE. The indications for DBE was obscure GI bleeding (OGIB) (n=12), followed by DBE-ERCP (n=14), and evaluation of and abdominal pain (n=8) and placement of direct feeding jejunostomy (n=3). The excluded stomach was successfully reached in 85% of patients with Roux-en Y gastric bypass. The overall diagnostic yield of DBE-ERCP was 70% (stones n=4, sphincter stenosis n=2, bile leak n=2, bile duct stricture n=2, failed ERCP n=4). The yield of DBE for abdominal pain was 20% (n=2: gastric erosions, gastro-gastric fistula) and DBE for OGIB 75%. Of the 14 patients with OGIB, 10 had active or a source of bleeding at the time of DBE. In all but one case, the bleeding was occurring at the site of the anastomosis, whether that is hepaticojejunal, jejunojejunal, or gastrojejunal. Of these patients, 4 patients had arteriovenous malformations at the anastomotic site, 4 had ulcers or erosions, and 2 were bleeding secondary to Dieulafoy’s lesions. A total of one complication (3%) was observed (small bowel perforation after application of argon plasma coagulation to the jejunojejunal anastomosis). Conclusion: DBE is a feasible and relatively safe technique to evaluate the small intestines, stomach and biliary tract and is associated with reasonably high diagnostic and therapeutic yield in patients with surgically altered bowel anatomy in the setting of bariatric surgery.