Double Balloon Device Research Articles

Overtube Assisted Enteroscopy Using the Spiral Tip Overtube (OAE-Spiral): Single Group Experience in Patients with Normal and Altered Anatomy

Introduction: Therapeutic small bowel endoscopy is now possible with the introduction of overtube assisted enteroscopy. The double balloon device requires two operators, the single ballon is simpler, and the spiral tip overtube is the most recent to be introduced. We report our initial experience. Aims and Methods: The endoscopy database was searched from 1/2008 to 10/2008 for overtube assisted enteroscopy (OAE) using the spiral tip overtube (spiral). The OAE-spiral was performed using an Olympus SIF Q180 enteroscope preloaded with the 48F 118cm long Discovery SB overtube with a 21 cm long 5 mm tall spiral at the tip(Spirus Medical, Stoughton, MA). The small bowel is pleated using clockwise rotation of the overtube, with reductions that advance the endoscope through the small bowel. Maximal insertion depth is estimated by adding endoscope advancements, and subtracting the amount of scope that is pulled back during reductions. Results: Twenty-one patients (8 males, 12 females) underwent OAE-spiral. Mean age was 55 yrs (SD ± 17 yrs). Indications were iron deficiency anemia (n = 9), obscure overt gastrointestinal bleeding (n = 2), unexplained abdominal pain (n = 7), ERCP after gastric Roux-en-Y bypass (n =2) and fistula plug placement for entero-cutaneous fistula (n =1). Mean total procedure time was 51 minutes (SD ± 21 minutes). Sedation was achieved with propofol; one patient required general anesthesia. 14 patients had normal small bowel anatomy and 7 patients had Roux-en-Y anatomy. The proximal to mid-ileum was reached in 93% of patients (n = 13) with normal anatomy. Two of the 13 had small bowel angioectasia and were treated with APC; 1 patient had yellow nodules (lymphangioma). OAE-spiral reached the ileal fistula and a plug was placed with short-term control of drainage. In the 7 patients with Roux-en-Y anatomy, an enteral anastomotic stricture was seen in 2 patients which were successfully treated with endoscopic balloon dilation. Both had an orthotic liver transplant (OLT) and one had previous single ballon endoscopy failure. The ampulla was not reached for ERC in one patient with Roux-en-Y anatomy. ERC was successful with the OAE-spiral in the second patient who had a failed single ballon. Complications included mild to moderate mucosal trauma, hematomas, and a jejunal perforation in one patient. Conclusions: OAE-spiral offers deep small bowel access in a reasonable amount of time and therapy that was previously only available by intra-operative enteroscopy or laparotomy. It also was successful after failure of the single balloon overtube. Rigorous studies to determine how it compares to single or double balloon enteroscopy are needed.

Induction of labor in women with previous cesarean section using the double balloon device

Induction of labor in women with previous cesarean section using the double balloon device

Comparison between a double balloon device and the foley catheter in extraamniotic prostaglandin F2α infusion for termination of midtrimester missed abortion

Comparison between a double balloon device and the foley catheter in extraamniotic prostaglandin F2α infusion for termination of midtrimester missed abortion

Ripening and dilatation of the unfavourable cervix for induction of labour by a double balloon device: experience with 250 cases.

To determine the efficacy of the double balloon device (the Atad Ripener Device) in ripening and dilatation of the unfavourable cervix for induction of labour. Two hundred and fifty women with unfavourable cervices (Bishop score < or = 4) underwent induction of labour with the Atad Ripener Device. Indications were pregnancy induced hypertension (n = 118), post-dates (n = 69), elective inductions (n = 23), other reasons including nonreassuring nonstress test, intrauterine growth retardation, previous caesarean section and diabetes mellitus (n = 40). The Atad Ripener Device was inserted into the cervix, the uterine balloon inflated in the internal os, and the cervico-vaginal balloon in the external os of the cervix (100 mL of normal saline to each balloon). Pressure produced by the inflated balloons caused gradual dilatation and effacement of the cervix. The Atad Ripener Device was removed 12 h after insertion, the cervix assessed again, and labour managed according to obstetrical criteria. The Atad Ripener Device caused an increase in the Bishop score in all subgroups with a mean change of 4.6 (from 2.0 prior to induction to 6.6 upon removal of the Atad Ripener Device; P < 0.05). The mean time interval from insertion of the Atad Ripener Device to delivery was 18.9 h, and from removal to delivery was 6.9 h. Caesarean section was performed in 39/250 patients (16%), and the others had a normal vaginal delivery. 1. The double balloon device induces significant ripening and dilatation of the unfavourable cervix. 2. Induction of labour was successfully achieved following removal of the Atad Ripener Device. 3. Our caesarean section rate was low compared with rates reported for women with an unfavourable cervix induced by other methods.

A randomized comparison of prostaglandin E 2 oxytocin, and the double-balloon device in inducing labor

To compare the efficacy of three methods for ripening and dilating the unfavorable cervix for induction of labor. Pregnant women having an indication for induction of labor with a singleton vertex fetus, intact membranes, and Bishop score of no more than 4 were randomized to one of three induction methods: intravaginal prostaglandin (PG) E2 tablets (3 mg) followed by a second dose if labor did not start; continuous intravenous oxytocin drip; or the Atad Ripener Device, with inflation of both balloons and removal after 12 hours. For all patients, the cervix was assessed by the same investigator before induction and 12 hours later. Thirty subjects were included in the PGE2 group, 30 in the oxytocin group, and 35 in the Atad Ripener Device group. The postpartum course was comparable in all. The change in Bishop score in the PGE2 and Atad Ripener Device groups was significantly better than in the oxytocin group (median and range of 5[0-9] and 5[0-7], respectively, versus 2.5 [0-9]; P < .01). Cervical dilation more than 3 cm was more frequent in the Atad Ripener Device group compared with both the PGE2 and oxytocin groups (85.7 versus 50 and 23.3%, respectively; P < .01). The trial of induction failed in only two patients (5.7%) in the Atad Ripener Device group, compared with six (20%) in the PGE2 and 16 (53.3%) in the oxytocin groups (P < .001). Mean (+/- standard deviation) induction-to-delivery interval was 21.3 +/- 7.0 hours in the Atad Ripener Device group, 23.2 +/- 12.5 hours in the PGE2 group, and 28.2 +/- 14.7 hours in the oxytocin group. The success rate for vaginal delivery was significantly better in the Atad Ripener Device and PGE2 groups compared with the oxytocin group (77.1 and 70%, respectively, versus 26.7%; P < .01). The Atad Ripener Device had a significantly better success rate for cervical dilation and a lower failure rate than those for PGE2 and oxytocin. The PGE2 and Atad Ripener Device groups had better results than the oxytocin group in regard to Bishop score change and induction-to-delivery interval. The Atad Ripener Device may be a superior method for cervical ripening and labor induction in patients with unfavorable cervices.

482 Ripening and Dilation of the Unfavorable Cervix for Induction of Labor by a Double Balloon Device (DBD) as Non-Pharmaceutical Method

482 Ripening and Dilation of the Unfavorable Cervix for Induction of Labor by a Double Balloon Device (DBD) as Non-Pharmaceutical Method

Simplified method for diagnosis of Hirschsprung's disease.

Methods and Materials Pressures are recorded from the internal anal sphincter by a double balloon device tied around a hollow steel cylinder forming two separate compartments (Fig. 1). With both balloons deflated, this device is gently inserted into the anus. The internal balloon is inflated with 10 ml. air through a three-way stopcock and kept inflated by closing the stopcock. The recording device is then gently pulled caudad until resistance is met. At this point, the extemal balloon is inflated with 10 ml. air and its stopcock is closed. The recording device will then be in the correct position and remain there. A third balloon is inserted 5 cm. beyond the recording device through its hollow core. Rectosphincteric reflexes are initiated by transiently distending the rectal balloon by rapidly injecting and withdrawing 10-50 ml. air via a hand syringe. The time required to depress and withdraw the plunger of the syringe is approximately two seconds. Pressure changes are recorded by an aneroid manometer, which is attached to the stopcock of the inner balloon (Fig. 2). When the stopcock is opened to provide communication with the manometer, pressure recordings of 50-90 mm. Hg indicate that the balloon is in position. Studies were made on 6 subjects (age 19 months to 80 years) with functional constipation and 3 subjects (14 months to 7 years) with Hirschsprung's disease proven by biopsy, and the results of this simplified method were compared to those obtained by the pressure transducerst and Sanborn recordert

Nonsurgical test for the diagnosis of Hirschsprung's disease.

A manometric technic is described for the diagnosis of Hirschsprung's disease without the necessity of deep-muscle rectal biopsy. Separate pressure recordings were obtained from the internal and external anal sphincters by a double balloon device and from the rectum by a third balloon. Simultaneous electromyographic activity was recorded from the external sphincter by a concentric needle electrode. In 34 normal subjects transient distention of the rectal balloon produced reflex relaxation of the internal sphincter (smooth muscle) and contraction of the external sphincter (striated muscle), with a simultaneous increase of electrical activity in the external sphincter. In 10 patients with Hirschsprung's disease, there was contraction of the internal sphincter instead of relaxation. External sphincter responses were normal. In 31 patients with idiopathic megacolon, both internal and external sphincter responses were normal, indicating that the abnormal contractile response found in Hirschsprung's disease is characteristic of this disorder and not of megacolon in general. This contractile response may contribute to obstructive symptoms in Hirschsprung's disease.