Double-balloon Enteroscopy In Patients Research Articles

A Prospective Study on Evaluating the Diagnostic Yield of Video Capsule Endoscopy Followed by Directed Double-Balloon Enteroscopy in Patients with Obscure Gastrointestinal Bleeding

A Prospective Study on Evaluating the Diagnostic Yield of Video Capsule Endoscopy Followed by Directed Double-Balloon Enteroscopy in Patients with Obscure Gastrointestinal Bleeding

Double-balloon enteroscopy: The diagnosis and management of small bowel diseases

Double-balloon enteroscopy is a novel endoscopic technique developed to investigate small bowel diseases. The aim of this study was to evaluate the diagnostic and therapeutic impact of double-balloon enteroscopy in patients with suspected or documented small bowel disease who were referred to our tertiary center, which was the first to introduce the double-balloon enteroscopy system in Turkey. This is a single-center prospective study. A total of 216 double-balloon enteroscopy procedures (168 antegrade, 48 retrograde) were done in 188 patients who were referred to our center for suspected small bowel disease. The main outcome measurements were complications, insertion depth and duration, and diagnostic and therapeutic rates. Indications included obscure gastrointestinal system bleeding, iron deficiency anemia, abnormality on radiographic evaluation, abdominal pain, diarrhea, and suspected celiac disease. A diagnosis was established in 130 (69%) patients. The most common pathologic findings included angiodysplasias (29%), ulcerations (16%) and Crohn's disease (9%). Mean time±standard deviation to perform the examination using the antegrade route was 116.4±7.17 min, and the average±standard deviation insertion length was 310.65±90.3 cm (beyond the pylorus). Therapeutic interventions were performed in 66 patients (56 angiodysplasias, 4 ulcers, 4 strictures, and 2 polyps), and the success rate was 97%. No serious complication was observed, although pancreatitis occurred in 6 of 48 (12.5%) patients who were followed up for post-procedure pancreatic enzyme levels. Our prospective analysis suggests that double-balloon enteroscopy is a feasible and useful technique for the diagnosis as well as treatment of small intestinal disorders.

Clinical Significance of Small Intestinal Involvement Detected by Double-Balloon Enteroscopy In Patients with Non-Hodgkin's Lymphoma

AbstractAbstract 5075 Introduction:Small intestinal lesions without abdominal symptoms are not usually evaluated because of anatomical difficulties with the diagnostic approach to the small intestine. Double-balloon enteroscopy (DBE) can detect gastrointestinal tract lesions of lymphoma, in addition biopsy samples can only be obtained using DBE. Here, we examined the feasibility of DBE to detect small intestinal involvement as well as the clinical significance of such involvement in patients with non-Hodgkin's lymphoma (NHL). Patients and methods:We prospectively screened consecutive patients with first-onset NHL who were admitted to our hospital between March 2004 and August 2009. Among them, adults aged between 18 and 85 years were eligible for inclusion if (1) they had lymphoma infiltration in the stomach, duodenum or colon proven by gastrointestinal endoscopy or colonoscopy, (2) small intestinal involvement was suspected by computed tomography (CT) or Ga scintigraphy (Ga-Scinti)/ 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), or (3) any gastrointestinal symptoms were present. All patients provided written informed consent. Patients underwent DBE using a Fujinon system. Patients with CD20+ B-cell lymphoma received 6–8 cycles of either R-CHOP or R-THP-COP therapy. The R-THP-COP regimen included THP, an anthracycline derivative of DOX with reportedly lower cardiotoxicity than DOX. The patients with CD20-lymphoma received 6–8 cycles of CHOP or THP-COP therapy. Patients with bulky disease underwent radiotherapy ranging from 30 to 40 Gy after chemotherapy. Patients who relapsed or whose disease progressed after first line chemotherapy, and those who were resistant to first line chemotherapy, received the P-IMVP-16/CBDCA (methylprednisolone, ifosfamide, methotrexate, etoposide and carboplatin) regimen with or without R as a second line therapy. Some patients with refractory or relapsed NHL who responded to (R)-P-IMVP-16/CBDCA received high-dose chemotherapy followed by autologous stem cell transplantation. Results:Among 318 patients with histologically confirmed NHL between 2004 and 2009. 58 patients were eligible for DBE. Unfortunately, we could not achieve the informed consent in 16 patients and clinical conditions were too severe to undergo DBE in 4 patients. After all, we could undergo DBE in 38 patients. Their median age of the 38 patients was 65 years (range, 38–82). We confirmed small intestinal involvement in 21 (55%) of 38 patients by DBE. Complete remission (CR) or CR uncertain (CRu) rates of patients with small intestinal involvement of lymphoma (n=21, 48%) was significantly lower than that in other patients (n=297, 71%) or that in patients without small intestinal involvement confirmed by DBE (n=17, 88%). The 3-y OS rate of the patients with small intestinal involvement of lymphoma (n=21, 41%) was significantly lower than that in other patients (n=297, 77%) (P<0.0001) and that in patients without small intestinal involvement confirmed by DBE (n=17, 88%). The impact of small intestinal involvement on survival was compared using multivariate analysis with those of current clinicopathological prognostic factors. Small intestinal involvement of lymphoma was the significant prognostic factor in all lymphoma patients (3.25; 1.50–6.40; p = 0.0039) and in the patients who underwent DBE (4.59; 1.03–32.5; p = 0.0444). Aspiration pneumonia developed in 3 of 38 patients after DBE, but they improved with antibiotic therapy. No deaths were associated with DBE. Conclusion:The small intestinal involvement might indicate a poor prognosis. DBE can directly and precisely evaluate the lesions and thus help to determine the most appropriate treatment strategy for such patients. Disclosures:No relevant conflicts of interest to declare.

Single- vs. Double-Balloon Enteroscopy in Patients With Small-Bowel Disorders: The Jury Is Still Out

1Department of Gastroenterology, Conquest Hospital, Hastings, UK 2Department of Gastroenterology, Guy's and St Thomas' Hospitals NHS, London, UK Correspondence: Simon D. McLaughlin, MBBS, MRCP, Department of Gastroenterology, Conquest Hospital, Hastings, UK. E-mail: [email protected]

S1438: ERCP by Short Double Balloon Enteroscopy in Patients With Altered Gastrointestinal Anatomy

ERCP is technically challenging in patients with altered gastrointestinal anatomy. A recently introduced double balloon enteroscope permits the examination of a much longer segment of the small bowel compared with a conventional endoscope, and may be used to perform ERCP in these patients.

Endoscopic therapy of small-bowel polyps by double-balloon enteroscopy in patients with Peutz-Jeghers syndrome

Peutz-Jeghers syndrome (PJS) is a hereditary disorder characterized by mucocutaneous pigmentations and hamartomatous polyps mainly in the small bowel. These polyps may cause complications such as intussusception. To assess therapeutic efficacy and safety of double-balloon enteroscopy (DBE) for detection and treatment of small-bowel polyps in patients with PJS. Prospective cohort study. Tertiary-care referral center. This study involved 13 patients with PJS, defined as a proven STK11 gene mutation or according to international diagnostic criteria. DBE with enteroscopic removal of pedunculated polyps of > or =10 mm. Location, number and size of small-bowel polyps, polypectomy data, and complications and long-term complications associated with development of small-intestine polyps. Thirteen patients with PJS (8 male, mean age 31 years) underwent 29 DBE procedures. Ten patients (77%) had a history of partial small-bowel resection because of small-bowel polyps. Small-bowel polyps were found in all 13 patients. The majority of polyps (94%) were located in the proximal jejunum. A total of 82 polyps of > or =10 mm were detected, and 79 (96%) were endoscopically removed without complications. After the introduction of DBE, no small-intestine-polyp-related complications occurred during a follow-up period of 356 person-months. Small number of patients. DBE is clinically useful and safe for diagnosis and therapy of small-bowel polyps in patients with PJS, even in patients with a history of extensive abdominal surgery. DBE may decrease the need for laparotomy in patients with PJS.

A Prospective Study on Evaluating the Diagnostic Yield of Video Capsule Endoscopy Followed by Directed Double-Balloon Enteroscopy in Patients with Obscure Gastrointestinal Bleeding

Video capsule endoscopy (VCE) and double-balloon enteroscopy (DBE) are two novel methods for examining the small bowel and could be complementary to each other. The aim of the present study is to prospectively evaluate the diagnostic yield of VCE followed by a directed DBE in patients with obscure gastrointestinal (GI) bleeding. Patients with obscure gastrointestinal bleeding for a complete VCE examination were involved in the study. DBE was recommended after a negative or indeterminate finding of VCE. The diagnostic and follow-up data were collected for analysis. A total of 190 patients with a complete VCE examination were enrolled in the study. The overall positive detection rate for small-bowel disease in the VCE group was 86.8% (165/190), while 63.7% (121/190) patients were definitely diagnosed. Fifty-one patients with indeterminate (44 cases) and negative (seven cases) findings of first VCE underwent DBE procedures. A total of 18 patients with negative VCE findings refused the further examination. DBE demonstrated a positive finding in 66.7% (34/51) patients, 33 from indeterminate group and one from the negative group. Following an unrevealing DBE, at surgical follow-up, three further negative DBE procedures were documented. The overall diagnostic yield was 88.9%, including 121 diagnoses made by VCE alone and 48 by both VCE and DBE (confirmed at surgery or other treatments). The negative predictive value (NPV) and positive predictive value (PPV) of DBE in indeterminate VCE were 81.8 and 100%, respectively. Capsule endoscopy followed by directed double-balloon enteroscopy is a good strategy for investigating the causes of obscure GI bleeding and especially in confirming indeterminate and negative findings from VCE.

Effective dilation of small-bowel strictures by double-balloon enteroscopy in patients with symptomatic Crohn's disease (with video)

Crohn's disease (CD)-related small-bowel strictures remain a major cause of morbidity, frequently requiring surgery. Assessment of the feasibility and effectiveness of CD small-bowel stricture dilation by DBE. Prospective case series. Single, tertiary referral center. Outcome data on cases of DBE-assisted CD small-bowel stricture dilation were prospectively collected from 2005. Dilation was performed by using controlled radial expansion balloon dilators. A 10-cm visual analogue scale (VAS) was used to assess obstructive symptoms and dietary restriction before DBE stricture dilation and at follow-up. A total of 13 DBEs were performed in 11 consecutive patients (mean +/- SD age 46.4 +/- 7.8 years). Eighteen small-bowel stricture dilations were performed in 9 of 11 patients. The mean dilation diameter was 15.4 mm (range 12-20 mm). In 2 cases, stricture dilation was not performed because adhesions made reaching the strictures impossible. One case was complicated by a delayed perforation. In the other 8 patients, stricture dilation was successful; VAS scores improved dramatically and none of the patients has required surgery (mean follow-up 20.5 months; range 2-41 months). During follow-up, 2 patients required repeated dilation (at 6.5 and 13 months, respectively) because of symptom recurrence. Clinical improvements in before and after VAS scores were significant (mean 8.8 vs 1.8, respectively; P < .001). Small case series; single tertiary referral center. DBE-assisted small-bowel stricture dilation for selected patients with CD is potentially of significant benefit and should be considered as a useful and effective alternative to surgery. Larger studies are required to confirm this benefit.

Endoscopic retrograde cholangiography by double balloon enteroscopy in patients with Roux-en-Y hepaticojejunostomy

In patients with Roux-en-Y hepaticojejunostomy (HJ), endoscopic retrograde cholangiography (ERC) cannot usually be achieved since the anastomosis is not reachable via standard duodenoscope. In this study, we report our experience with ERC using double balloon enteroscope (DBE) (DBE-ERC) in patients with HJ. The DBE-ERC procedures performed since the index case done dated May 3, 2006 have been overviewed. Fourteen patients underwent the procedure. DBE-ERC was successful in all but one patient, for whom the anastomosis could not be reached (success rate to reach anastomosis: 92.9%). The remaining 13 patients (7 female, 6 male; age 28-61 years, mean 45.3 years) had 20 sessions of DBE-ERC. The cannulation of the bile duct was achieved in all patients. The procedures, such as sphincteroplasty, dilatation, stone extraction and stent placement, were performed. Therapeutic procedures were all successful, except for in a single patient, who had the common bile duct filled with multiple stones and was referred for surgery. Three patients who had anastomotic stenosis treated by stenting are symptom free on follow-up at 3, 9 and 12 months, respectively, after stent removal. Retroperitoneal air was detected in a patient following stricturoplasty, but recovery was attained with medical treatment alone. Mean duration of the procedures was 75 +/- 62 min. DBE-ERCP enables us to perform ERC in a group of patients for whom it was impossible previously. Further experience is needed to evaluate its therapeutic efficacy compared with alternative methods.

859 Small Bowel Imaging Comparing MR Enteroclysis, Capsule Endoscopy and Double-Balloon Enteroscopy in Patients with (Suspected) Crohn's Disease; the COMRADE Study

859 Small Bowel Imaging Comparing MR Enteroclysis, Capsule Endoscopy and Double-Balloon Enteroscopy in Patients with (Suspected) Crohn's Disease; the COMRADE Study

Double Balloon Enteroscopy (DBE) in the Elderly: Indications, Findings, and Agreement with Video Capsule Endoscopy

Introduction: DBE is useful in the diagnostic evaluation and treatment of obscure GI bleeding and small bowel pathology. Limited data are available on indications, findings and agreement between DBE and video capsule endoscopy (CE) in older patients. Aim: To evaluate the distribution of indications, findings and overall agreement of DBE with CE in patients according to age (< or > 75 years). Methods: Retrospective review of DBE procedures at our center between August 2007 and August 2008 in patients divided by age (< and > 75 years). Results: A total of 216 DBE procedures in 170 patients (87 male, 144 White) were reviewed. The mean age of patients studied was 66 +/- 16.4 yrs. (range 20-95 yrs.). Within this group, 60 patients (79 procedures) were > age 75. The most common indications for DBE in patients > age 75 were obscure GI bleeding (96%) and abnormal CE (70.9%). The most common indications for DBE in patients < age 75 were obscure GI bleeding (79.6%), abnormal CE (66.4%), and abnormal SBFT/CT/MRI (14.6%). A higher percentage of patients > age 75 were on anti-platelet medications (42% vs. 33.6%) and anti-coagulation therapy (26.7% vs. 11.8%) compared to patients < age 75. The most common DBE findings in patients > age 75 were angioectasia (39%), erosion/ulcer (10.1%), and polyp/mass (9%). The most common DBE findings in patients < age 75 were angioectasia (23%), polyp/mass (14%), and erosion/ulcer (11.5%). In patients > age 75 there was agreement between DBE findings and CE findings in 19/43 patients (44.1%). In patients < age 75 there was agreement between DBE findings and CE findings in 23/72 patients (31.9%). Endoscopic therapy was indicated in 38/79 (48.1%) procedures for patients > age 75 and 45/137 (32.8%) procedures for patients < age 75. Endoscopic therapy was successful in 32/38 (84.2%) cases for patients > age 75 and 34/45 (75.6%) for patients < age 75. Conclusions: A greater percentage of patients > age 75 have angioectasias, and are more likely to require endoscopic therapy than younger patients, while patients < age 75 have a higher percentage of polyps/mass lesions found on DBE. The agreement between findings on DBE and prior abnormal CE are relatively low in both age groups. In patients > 75 the greater likelihood of finding angioectasias requiring therapy suggests that an earlier role for DBE in elderly patients may be appropriate.

Safety of Double Balloon Enteroscopy in Patients >Age 75 Years: A Single Center One-Year Experience

Introduction: Double Balloon Enteroscopy (DBE) is a useful modality in the diagnostic evaluation and treatment of obscure GI bleeding and small bowel pathology. Limited data are available on the safety of DBE in older patients. In this study we report our single center experience over a 1 year time period. Aim: To determine the relative safety of DBE in patients over and under the age of 75 yrs. Methods: Retrospective review of DBE procedures at our center between August 2007 and August 2008 in patients over and under the age of 75 yrs. Results: A total of 216 DBE procedures in 170 patients (87 male) were reviewed. The mean age of patients studied was 66 +/- 16.4 yrs. (range 20-95 yrs.). Within this group 60 patients (79 procedures) were > age 75 yrs. A total of 2 adverse events were seen (1 patient with hypoxia and 1 patient with a transient cardiac arrhythmia). Both of these adverse events occurred in patients <age 75 yrs. There were no adverse events encountered in patients > age 75 yrs. There were no perforations and no deaths in either group. There were no significant differences in procedure times for upper DBE (p=0.76) and lower DBE (p=0.89) in patients over and under the age of 75. Finally, there were no significant differences in depth of insertion/extent of small bowel examined for upper DBE (p=0.34) and lower DBE (p=0.47) in both groups. These data are summarized in the table below. Conclusion: DBE is safe in patients over the age of 75 yrs. There does not appear to be a significant difference in procedure times and extent of small bowel examined in patients over and under the age of 75 yrs. Tabled 1 All pts. Age <75 Age >75 # pts. 170 110 60 # procedures 216 137 79 Adverse Events 2/216 (0.9%) 2/137 (1.4%) 0/79 (0%) Upper DBE Mean Procedure Time (min) 67.9 +/- 20.4 68.2 +/- 22.6 67.2 +/- 16.3 Lower DBE Mean Procedure Time (min) 67.3 +/- 22.9 67.6 +/- 24.2 66.7 +/- 20.7 Mean Depth of insertion Upper DBE (cm) 218.3 +/- 96.6 225 +/- 97.5 208 +/- 94.2 Mean Depth of insertion Lower DBE (cm) 107.8 +/- 82.7 112 +/- 75.72 98 +/- 99.03 Open table in a new tab

Capsule Endoscopy (CE) Increases the Diagnostic Yield of Double Balloon Enteroscopy (DBE) in Patients Being Investigated for Obscure Gastrointestinal Bleeding (OGIB)

Background: Both capsule endoscopy (CE) and double balloon enteroscopy (DBE) are valuable methods for the evaluation of obscure gastrointestinal bleeding (OGIB). Many experts recommend the use of CE to guide DBE. However, the true impact of CE on the yield of DBE in the daily clinical practice has not been evaluated. We had the unique opportunity to observe the impact of CE on DBE in patients with OGIB, as the introduction of CE in our clinical setting occurred reversed, i.e. after DBE. Aim: To evaluate the impact of DBE on the yield of DBE in patients with OGIB.

30-Month Follow-Up After Double Balloon Enteroscopy in Patients with Obscure Gastrointestinal Hemorrhage

Background: Double Balloon Enteroscopy (DBE) is a useful endoscopic modality for diagnosis and treatment of small bowel abnormalities responsible for obscure gastrointestinal bleeding. Long-term outcomes after DBE have not been extensively published. Methods: We invited patients who had undergone DBE for obscure GI bleeding between 8/04-9/06 to participate. We contacted patients via phone in 11/06 and 11/08 in order to collect information regarding recurrent bleeding, need for transfusions, subsequent procedures, and need for iron therapy since the initial DBE examination. Results: We invited 274 patients to participate in the study; 135 (49%) patients agreed to participate with a mean (±SD) age of 64 ± 14.8 (range 23-90) years. For the first phase of the study, 101 (37%) patients were contacted with a mean follow-up time post-DBE of 10.5 ± 5 (range 2-26) months. The most common findings on DBE examination were AVMs found in 50 (43%) of patients during the anterograde approach. Recurrent or persistent anemia occurred in 34 (31%) patients: 14 (41%) had persistent anemia requiring transfusions and/or iron therapy, while 20 (59%) had ongoing overt bleeding. In the 32 patients with subsequent procedures post-DBE, AVMs were found in 8 (25%). Fifty-eight patients were subsequently contacted in 11/08 for a mean follow-up of 30 ± 7.3(range 18-47) months. The findings from the DBE examinations in these 58 patients included normal mucosa in 30 (52%), AVMs in 16(27.5%), inflammatory mucosa in 3, and other findings including Dieulafoy lesion (1), blue rubber nevus (1), lymphangiectasia (1), Meckel's diverticulum (1), ulcerations (3), and paraesophageal hernia (1). Six patients died of causes not related to bleeding. Recurrent bleeding occured in 12/52 (23%). Recurrent bleeding occured in 6 patients with normal DBE, 3 with AVMs, and in 4 other patients (1 blue rubber nevus, 1 radiation enteritis, 1 portal hypertensive enteropathy, 1 untreated Crohn's patient). 5 patients underwent repeat DBE, 4 small bowel resection, 1 surgical shunt, and 1 valve replacement. 7 patients received transfusions and 12 remained on iron therapy. Conclusions: 30 months post-DBE for obscure GI bleeding, the majority of patients (67%) who were contacted did not have recurrent bleeding, require transfusions or iron therapy. Patients with normal initial DBE examinations or AVMs were most likely to experience recurrent bleeding.

Treatment and Surveillance of Small Bowel Polyps Using Double Balloon Enteroscopy in Patients with Peutz-Jeghers Syndrome

Background: Peutz-Jeghers syndrome (PJS) is a hereditary disorder characterized by mucocutaneous pigmentation and hamartomatous polyps. Polyposis mainly occurs in the small bowel, which can lead to intestinal intussusception and bleeding. Using double-balloon enteroscopy (DBE) the whole small bowel can be endoscopically visualized and polypectomy can be performed during the same procedure. The aim of this study was to assess diagnostic and therapeutic efficacy, and safety using DBE for treatment and surveillance in PJS patients. Methods: Retrospectively, PJS patients who had DBE were evaluated, using the DBE-database of our institution. DBE procedural data, location, number and size of small bowel polyps, earlier findings on gastroduodeno- and colonoscopy were evaluated. Large polyps were defined as >10 mm in diameter and with a stalk. Results: Between October 2004 and November 2008 11 PJS patients (7 males, mean age 34 (17-51) years) were examined with DBE. In 9 (82%) patients earlier small bowel surgery was performed due to complicated small bowel polyps. All patients had known (multiple small) polyps in the stomach or duodenum, and, except for 1 patient, all had known colonic polyps. The indications for DBE were surveillance in 13 (54%), abdominal complaints in 7 (29%), and suspicion of small bowel polyps on magnetic resonance enteroclysis in 4 (17%) patients. A total of 24 DBE procedures, 21 proximal and 3 distal, were performed. Mean insertion depth of proximal and distal procedures was 231 (140-300) cm and 145 (140-150) cm, respectively. Mean duration time of DBE was 72 (60-100) minutes. Conscious sedation was used in 14 (58%) procedures and general anesthesia was used in 10 (42%) procedures. Small bowel polyps were found in all patients, and in 22 (92%) procedures. A total of 72 large polyps were found, 68 (94%) of which were located in duodenum and proximal jejunum (within 150cm beyond ligament of treitz). In total 66 (92%) large polyps were removed using a polypectomy snare (maximal diameter 50 mm) after injection of the stalk with a diluted epinephrine-saline solution. No complications occurred. After introduction of DBE as surveillance technique in this PJS patients group, no complicated small bowel obstruction occurred after a follow-up of 252 person months (23 months per patient). Conclusions: DBE seems safe and clinically useful for diagnosis and therapy of small bowel polyps in PJS patients, even in patients with earlier extensive abdominal surgery. As majority of polyps are found in the proximal small bowel, proximal DBE is the preferred route in these patients. DBE can decrease the need for laparotomy in PJS patients.

ERCP Using Double-Balloon Enteroscopy in Patients with Roux-en-Y Anatomy

Double-balloon enteroscopy (DBE) is a useful method for endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y anatomy. Depending on the distorted anatomy, endoscopic therapies with conventional scopes were very difficult or impossible before the advent of DBE and patients had to be submitted to a percutaneous or surgical approach. The case of 6 patients with different types of Roux-en-Y-altered anatomy in which DBE-ERCP was performed with 83.3% successful rate (5/6) is reported confirming recent data in the literature on the feasibility of this method.

Commentaire de travail de A. Madisch et al., pp. 731

See also: Less favorable clinical outcome after diagnostic and interventional double balloon enteroscopy in patients with suspected small-bowel bleeding?Endoscopy 2008; 40(09): 731-734DOI: 10.1055/s-2008-1077521

Less favorable clinical outcome after diagnostic and interventional double balloon enteroscopy in patients with suspected small-bowel bleeding?

Double balloon enteroscopy (DBE) is a new endoscopic technique that allows diagnosis and therapeutic interventions of small-bowel lesions. One of the main indications for DBE is suspected small-bowel bleeding (SSBB). Data about clinical outcome after DBE are limited. The aim of the present study was to prospectively assess the short-term clinical outcome of this procedure. Of all consecutive patients undergoing DBE for various indications, follow-up results in patients with SSBB were analyzed. Standardized questionnaires were used, including assessment of gastrointestinal symptoms, especially signs of gastrointestinal bleeding, blood transfusions, demand for re-intervention, and hospitalization. Of a total of 180 DBEs performed in 124 patients during a 2-year period, SSBB was the indication in 84 patients (M/F = 46/38; mean age 63 years) who underwent a total of 111 DBEs. Of these patients 52 could be followed (mean follow-up 2 months, range 1-5 months). In this subgroup, positive findings were obtained in 30 (mostly angiodysplasia), with therapeutic interventions being performed in 18 of these patients. At follow-up, the rate of re-bleeding in patients who had undergone interventions (20%) was similar to that in patients who had not (18%). In this pilot study, DBE did not seem to have a major effect on re-bleeding. Better patient selection or modification of therapeutic regimens appears to be necessary to better utilize DBE in SSBB.

Utility of Double Balloon Enteroscopy for Surveillance in Intestinal Polyposis Syndromes

Patients with familial polyposis and non-hereditary polyposis syndromes are at increased risk of developing not only colorectal cancer, but also small bowel carcinomas, with up to a 12% lifetime incidence of cancer development. The knowledge of the distribution and features of small bowel polyps in these patients has improved since the introduction of capsule endoscopy (CE) and double balloon enteroscopy (DBE). Although there are few studies which evaluate the results of CE and DBE in patients with polyposis syndromes, it appears that DBE is a more accurate method to detect small bowel polyps, additionally allowing the retrieval of biopsies and polypectomy.

A prospective, single-blind trial comparing wireless capsule endoscopy and double-balloon enteroscopy in patients with obscure gastrointestinal bleeding

Wireless capsule endoscopy (CE) and double-balloon enteroscopy (DBE) are new methods enabling diagnostic endoscopy of the entire small intestine. However, which of the two is superior is unclear. We therefore prospectively compared the clinical efficacy of CE and DBE. We prospectively examined 32 patients with obscure gastrointestinal bleeding. CE preceded DBE by 1-7 days, and all patients underwent DBE twice, by antegrade and retrograde approaches, to evaluate the entire small intestine. Physicians evaluating the results of CE and DBE were blind to the results of the other method. We evaluated diagnosis, diagnostic yield of the two methods, and clinical outcomes. CE revealed abnormal findings in 29 (90.6%) of 32 patients. CE definitively or probably detected the sources of bleeding in 23 (71.9%) of the 32 patients, including angioectasias (eight), erosions (seven), ulcers (five), tumor (one), and hemorrhagic polyps (two). DBE definitely or probably detected the sources of bleeding in 21 (65.6%) of the 32 patients, including angioectasias (seven), erosions (four), ulcers (five), tumor (one), hemorrhagic polyps (two) and diverticula (two). CE yielded more abnormal findings than DBE (CE 90.6%, DBE 65.6%) (P = 0.032), although there were no significant differences in diagnostic yield between the methods. We were able to perform additional treatment or biopsy with DBE in 13 patients, including coagulation therapy (ten), endoscopic mucosal resection (one), biopsy (seven), and extraction of retained CE (two). Our results demonstrate the superiority of CE in detecting abnormal lesions, and the superiority of DBE in endoscopic management.