Use Of Double-balloon Enteroscopy Research Articles

P032 Clinical Usefulness of Double Balloon Enteroscopy in Patients With Established or Suspected Small Bowel Crohn's Disease.

The diagnosis of isolated small bowel Crohn's disease (CD) can be challenging. Symptoms are non-specific and both imaging and capsule endoscopy (CE) may be misleading as several diseases may mimic CD. Double balloon enteroscopy (DBE) allows a more extensive endoscopic and histologic evaluation of the small bowel. Our aim was to describe the diagnostic utility and impact of DBE on management of patients with known CD and in patients with suspected/rule-out CD. Retrospective review of our institution's DBE database from February 2009 to May 2013. Adult patients referred for DBE for further evaluation of known or suspected CD (due to symptoms, abnormal imaging and/or CE) were included. Patient demographics, clinical characteristics, imaging and CE results, prior DBE, indication for DBE, DBE findings, DBE adverse events, pathology findings, final diagnosis, treatment prior and post DBE and follow-up DBE were abstracted from the electronic medical record. A total of 108 patients were included, 61 (56%) females, mean age 52 years (range 20-83). Indications for DBE included: disease activity assessment/therapeutic in 10 patients with established diagnosis of CD and for diagnostic purposes in 98 patients with suspected CD (31 patients due to abnormal imaging, 29 due to abnormal CE and 26 due to both abnormal imaging and CE). Upper, lower, bidirectional upper and lower, and stomal DBE were performed in 21, 24, 62 and 1 patients, respectively. DBE revealed active disease in 8/10 patients with known CD with one patient undergoing dilation of a stricture. Changes in management were recommended for all patients with active disease - start thiopurine (2), optimize thiopurine dose (1), start biologics (3) change biologics (1), systemic steroids (1) and budesonide (1). The patient who underwent stricture dilation ultimately required surgery. A definitive diagnosis of CD (both endoscopic and histologic) was reached in only 39/98 (40%) patients who were referred for suspected CD. Changes in management were recommended in 32/39 (82%) patients. Interestingly, 24/98 patients had been diagnosed with CD at outside institutions and were recommended to initiate therapy for CD. Of these, CD was confirmed in only 15/24 (63%) patients. Adverse events included perforation in 1 patient (1%) who required surgical management and mouth swelling/abrasion in 3 patients (3%). Follow-up DBE to re-assess disease activity was performed in 10/49 (20%) patients with definitive diagnosis of CD, average time between procedures 4.5 years (range 0.7-11.6). One patient with CD was diagnosed with lymphoma 2.4 years after initial DBE. Changes in management were recommended in 6 patients: de-escalation of therapy (3, two underwent surgery), start thiopurine and/or biologic (2) and switch biologics (1). No complications were seen at follow-up DBE. DBE is a useful technique to confirm a diagnosis in patients who have suspected CD and can help establish a diagnosis of several diseases that may mimic CD on CT scan or CE. Additionally, DBE in patients with established diagnosis of small bowel CD is an effective tool to assess disease activity and guide therapy. Serious complications are infrequent.

Use of double-balloon enteroscopy to extract a partial denture embedded in the ileum for 5 weeks.

Use of double-balloon enteroscopy to extract a partial denture embedded in the ileum for 5 weeks.

The usefulness of double-balloon enteroscopy for colonic stent placement: A case report

The usefulness of double-balloon enteroscopy for colonic stent placement: A case report

Meckel's diverticulum with polypoid hyperplasia of ectopic gastric mucosa diagnosed by double-balloon enteroscopy and single-photon emission computed tomography/computed tomography.

Meckel’s diverticulum (MD) is a relatively common true congenital diverticulum on the ileum. Bleeding caused by polypoid hyperplasia of ectopic gastric mucosa in MD is rare. A 14-year-old Chinese boy presented with intermittent melena and haematochezia for 1 month. Laboratory data showed normocytic anaemia. Gastroscopic findings were normal. The patient underwent exploratory laparotomy without bowel preparation on day 2 because of sudden haematochezia and decreased haemoglobin. Intraoperative colonoscopy revealed inflammatory changes in the terminal ileal mucosa with diffuse haemorrhage. Melena with decreased haemoglobin recurred 20 days after the first operation. Computed tomography (CT) and angiography revealed a tubular lesion that was localised in the right lower abdominal quadrant. Single-photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging with 99m-technetium pertechnetate confirmed moderately increased uptake in the distal ileum. Retrograde double-balloon enteroscopy (DBE) showed a diverticulum with prominent mucosal polypoid hyperplasia at an insertion depth of 100 cm from the anastomotic stoma. Diverticulectomy and end-to-end anastomosis were performed, and MD was confirmed by a histopathological examination. The patient’s postoperative recovery was uneventful during the 2-month follow-up. MD with polypoid hyperplasia of ectopic gastric mucosa is rare. Complementary use of DBE and SPECT/CT can accurately diagnose MD by providing anatomical and functional information.

2582 Diagnosis of Meckel's Diverticulum With Double Balloon Enteroscopy

INTRODUCTION: Meckel's diverticulum (MD) is the most common congenital malformation of the gastrointestinal (GI) tract, present in 2-4% of the population. Typically, it presents as GI bleeding and is usually diagnosed in childhood. However, some patients may remain asymptomatic through adulthood or present later in life with complications. We describe an unusual case of an adult male presenting with abdominal pain and maroon stools, who underwent an extensive workup and was eventually diagnosed with MD only after a double-balloon enteroscopy (DBE). CASE DESCRIPTION/METHODS: A 29-year-old male with no significant medical history, presented with epigastric pain and melena for 2 days. He was initially hemodynamically stable with an admission hemoglobin of 8 g/dL. During his hospitalization, he passed intermittent maroon blood clots resulting in a hemoglobin drop to 6 g/dL, requiring 4 units of pRBCs. He had an extensive diagnostic workup including an EGD, colonoscopy, Meckel's scan, CT angiogram & push enteroscopy, which did not reveal a source of bleeding. Finally, a video capsule endoscopy showed active bleeding at 67% small bowel transit time. An anterograde DBE was then performed which showed no evidence of bleeding. Afterward, a retrograde DBE revealed a single bleeding diverticulum in the mid-ileum. The area was tattooed, and general surgery performed a laparoscopic small bowel resection of the Meckel's diverticulum. Pathology of the resected specimen was consistent with Meckel's diverticulum. The patient has remained asymptomatic since the surgery. DISCUSSION: We report the case of a young adult patient who presented with typical symptoms of Meckel's diverticulum but negative diagnostic examination with common practice Meckel's workup. A diagnosis was made only after the use of DBE after symptoms persisted, which calls to question whether certain imaging modalities are superior in adult-onset Meckel's than in the pediatric population in detecting MD. The sensitivity and specificity of Meckel's scan in children is 85% and 95%, respectively, but decreases to 62.5% and 9% in adults. A retrospective case-series found that DBE had a significantly higher mean diagnostic accuracy of 85.0% for MD compared to 21.4% for Meckel's scan. Mean diagnostic accuracies of other tests were as follows: VCE (36%), CT (32%), and angiography (10%). We suggest utilizing DBE much earlier in the diagnostic workup, in conjunction with capsule endoscopy, to better optimize diagnostic yield.

Double-balloon enteroscopy–facilitated cyanoacrylate-injection endotherapy of small-bowel varices: an international experience from 2 European tertiary centers (with videos)

Small-bowel varices (SBVs) are an uncommon consequence of portal hypertension. Radiologic intervention is usually considered for first-line management. When radiologic intervention is not possible, management options become very limited. The aim of this study was to evaluate the usefulness of double-balloon enteroscopy (DBE)-facilitated cyanoacrylate-injection endotherapy of SBVs. This was a retrospective review of DBE-facilitated cyanoacrylate-injection endotherapy of SBVs (December 2015 to October 2016). Ten DBEs were performed in 6 patients (4 women; median age, 68.5 years). No radiologic or surgical options were deemed feasible. Thirteen nests of SBVs were identified and injected with cyanoacrylate glue without hemorrhagic or embolic adverse events. At the 30-day follow-up after therapy, only 1 patient had experienced a mild recurrence of mid-gut bleeding; this was managed conservatively. One patient presented with acute GI bleeding 7 months later, and a repeat DBE with cyanoacrylate-injection endotherapy was successfully performed. One patient succumbed to his underlying advanced cholangiocarcinoma after 2 months. The remaining patients had a median follow-up of 12 months without any recurrent GI bleeding. DBE-facilitated cyanoacrylate-injection endotherapy of SBVs appears to be a safe and effective option when other first-line options are not feasible.

Impact of Double Balloon Enteroscopy (DBE) on Resource Utilization for Evaluation of Obscure Gastrointestinal Bleeding

Introduction: Gastrointestinal bleeding (GIB) is a common health care issue associated with significant utilization of economic resources. Evaluation requires the use of multiple modalities such as EGD, colonoscopy, video capsule endoscopy (VCE) and CT angiography. In approximately 5% of patients no source is identified via said methods. Double balloon enteroscopy (DBE) has emerged as a diagnostic and therapeutic procedure for obscure GIB. We aimed to determine if performing DBE reduced resource utilization in terms of subsequent procedures and interventions. Methods: A retrospective cohort study was conducted of patients (n=356) who underwent DBE for evaluation of OGIB between Nov 2012 and Aug 2016. Outcomes assessed include procedures performed (EGD, colonoscopy, VCE, blood transfusions) within 6 months prior to initial DBE and for repeat procedures including repeat DBE (antegrade and retrograde) 6 months after initial intervention. The relative risk ratio (RR) and its 95% confidence interval (95%CI) was used indicate the difference between post and pre-intervention. Generalized estimating equation (GEE) approach was used to evaluate the relative risk (RR), accounting for repeated measures. Results: Of 356 patients, a total of 256 were performed in 121 patients prior to initial intervention. Amongst these patients, 25 % (n=89) had at least one EGD, 11.5 % (n=41) colonoscopy, 18.3 % (n=65) VCE and 3.9% (n=14) CT angiography performed before intervention. Post intervention, a total of 145 procedures was applied to 82 patients including antegrade and retrograde DBE. The GEE analysis suggested that the risk of receiving procedures significantly decreased post intervention, with relative ratio RR=0.57 (0.42, 0.76), p<.0001. Similarly, for blood transfusions: before the intervention 311 blood transfusions were applied to 47 patients; while after the intervention, only 181 blood transfusions were applied to 38 patients. The risk of receiving blood transfusions significantly decreased post intervention, with RR=0.58 (0.34, 0.98), p=0.0431. Conclusion: DBE is an effective procedure for identifying and treating obscure gastrointestinal bleeding. It results in a significant decrease in number of procedures employed for identifying GIB, if utilized earlier during the course evaluation. The lack of availability of DBE at most centers is a limitation to its utility. There is a need for more frequent use of DBE for GIB to limit the expenditure on unwanted interventions.

The Safety and Utility of Double Balloon Enteroscopy in the Evaluation and Treatment of Gastrointestinal Bleeding in Patients With Left Ventricular Assist Devices: A Retrospective Review

The Safety and Utility of Double Balloon Enteroscopy in the Evaluation and Treatment of Gastrointestinal Bleeding in Patients With Left Ventricular Assist Devices: A Retrospective Review

Successful removal of an internal pancreatic stent that migrated into the bile duct using double-balloon enteroscopy after pancreaticoduodenectomy.

Internal stents used during pancreaticoduodenectomy (PD) are generally spontaneously passed through the rectum by defecation. However, we encountered six patients with internal stents that migrated into the bile duct after PD. We herein report the outcomes of these six patients and the usefulness of double-balloon enteroscopy (DBE) for removal of such stents from the bile duct. An internal stent was placed across pancreaticojejunostomy in 416 (68.8%) of 605 consecutive patients undergoing PD between 2005 and 2015. This study evaluated the characteristics and outcomes of the six patients whose internal stent migrated into the bile duct. Migration of an internal stent into the bile duct was found during follow-up computed tomography (CT) in 6 (1.4%) of 416 patients who had an internal stent placed during PD. Three patients developed stent-induced cholangitis, and two had bile duct stones. Excluding one patient whose internal stent spontaneously slipped out and disappeared from the bile duct, all patients underwent successful removal of a stent from the bile duct by a single instance of biliary intervention involving DBE. Removal of a stent from the bile duct using DBE is a feasible and useful procedure that should be considered if an internal stent is detected during follow-up CT after PD.

Double balloon enteroscopy in children: diagnosis, treatment, and safety.

To assess the feasibility and utility of double balloon enteroscopy (DBE) in the management of small bowel diseases in children. Fourteen patients (10 males) with a median age of 12.9 years (range 8.1-16.7) underwent DBE; 5 for Peutz-Jeghers syndrome (PJ syndrome), 2 for chronic abdominal pain, 4 for obscure gastrointestinal (GI) bleeding, 2 with angiomatous malformations (1 blue rubber bleb nevus syndrome) having persistent GI bleeding, and 1 with Cowden's syndrome with multiple polyps and previous intussusception. Eleven procedures were performed under general anesthesia and 3 with deep sedation. The entire small bowel was examined in 6 patients, and a length between 200 cm and 320 cm distal to pylorus in the remaining 8. Seven patients had both antegrade (trans-oral) and retrograde (trans-anal and via ileostomy) examinations. One patient underwent DBE with planned laparoscopic assistance. The remaining 6 had trans-oral examination only. The median examination time was 118 min (range 95-195). No complications were encountered. Polyps were detected and successfully removed in all 5 patients with PJ syndrome, in a patient with tubulo-villous adenoma of the duodenum, in a patient with significant anemia and occult bleeding, and in a patient with Cowden's syndrome. A diagnosis was made in a patient with multiple angiomata not amenable to endotherapy, and in 1 with a discrete angioma which was treated with argon plasma coagulation. The source of bleeding was identified in a further patient with varices. DBE was normal or revealed minor mucosal friability in the remaining 3 patients. Hence a diagnostic yield of 11/14 with therapeutic success in 9/14 was achieved. Double balloon enteroscopy can be a useful diagnostic and therapeutic tool for small bowel disease in children, allowing endo-therapeutic intervention beyond the reach of the conventional endoscope.

Use of Double Balloon Enteroscopy in Combination with Intracorporeal Laparoscopic Surgery for Small Bowel Disease

Use of Double Balloon Enteroscopy in Combination with Intracorporeal Laparoscopic Surgery for Small Bowel Disease

Mo1566 Utility of Double Balloon Enteroscopy in Patients With Surgically Altered Bowel Anatomy After Bariatric Surgery

database were reviewed to collect data. Results: 25 patients (17 women/8 men, mean age 45.3 10.6 years) were included. Post-operative collections occured after sleeve gastrectomy in 20 patients and after gastric bypass in 5. A median of 48 days (range 5-1071) elapsed between initial surgery and transfistulary stenting. 11 patients were treated by transfistulary stenting as primary treatment, while 14 patients had previously failed treatment attempts with one or more endoscopic methods (endoprosthetics, clips and/or fistula plugs). Internal drainage was initially maintained by placement of 2 double pigtail stents (7 or 8.5 Fr ) in 21 patients or by one stent and a naso-cystic catheter in 4. In 5 patients, transfistulary stenting was combined with percutaneous drainage. No complication occurred during the initial drainage procedure. In 6 patients, trans-fistulary stenting was not successful and surgery was necessary. Clinical success was achieved in 19 patients (76%). In 7 successfully treated patients, stents are still in place after a median stenting duration of 102 days (range 41-1620) and no complication has occurred. In 4 patients with spontaneous stent migration, no complication has occurred after a median follow-up duration of 137.5 days (range 85-390). In 8 patients, the plastic stents have been removed after a median stent indwell duration of 186.3 days (range 24-773) and no complication has occurred after a median follow-up duration of 159.4 days (range 5-461). In these patients, stents were either removed electively (2 patients) or because of dysphagia or symptomatic stent-induced esophageal ulcerations (6 patients). Conclusions: Trans-fistulary drainage of post-bariatric abdominal collections is safe and is associated with high success rates. This technique seems promising and can be considered either in previously untreated patients when a collection is present and not properly drained percutaneously or after failure of other endoscopic treatments. Mo1566 Utility of Double Balloon Enteroscopy in Patients With Surgically Altered Bowel Anatomy After Bariatric Surgery Shabnam Sarker, Shajan Peter, Ivan Jovanovic, Helmut Neumann, Monkemuller Klaus* Basil I Hirschowitz Endoscopic Center of Excellence, University of Alabama, Birmingham, AL Background: Endoscopic investigation of the gastrointestinal (GI) luminal and pancreatobiliary tracts in patients with surgically-altered GI anatomy after bariatric surgery is challenging and often impossible. The advent of balloon-assisted enteroscopy (BAE) has increased our ability to navigate through the surgically altered bowel. Despite the existence of BAE since more than a decade there is few data available on it potential utility for evaluation post-obesity-surgery patients. Aims: To evaluate the diagnostic yield, success and complications rates of double-balloon enteroscopy (DBE) in consecutive patients with GI problems necessitating endoscopic evaluation. Materials and Methods: Single-center, observational, cohort study of consecutive patients with post-obesity-surgery undergoing DBE during a 24-months period. Patients’ demographics, procedure indications, findings, endoscopic interventions, and post-procedural recovery data were recorded. Results: A total of 435 DBE were performed at our institution during the 24-months study period. Sixty-five patients (14.9%) with post-obesity surgery were evaluated using DBE. The types of surgery were: RYGB, gastric sleeve, lap-band. The indications for DBE was obscure GI bleeding (OGIB) (nZ18), ERCP (nZ31), and evaluation of and abdominal pain or diarrhea (nZ10) and placement of direct feeding jejunostomy (nZ6). The excluded stomach could be reached in 87% of patients with Roux-en Y gastric bypass. The overall diagnostic yield of DBE-ERCP was 68% (stones, nZ7, sphincter stenosis, nZ6, bile leak, nZ4, bile duct stricture, nZ4, failed ERCP, nZ10). The yield of DBE for abdominal pain was 40% (nZ4: gastric erosions, gastro-gastric fistula, anastomotic stricture and erosions) and DBE for obscure GI bleeding (61%). Of the 18 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, (hepaticojejunal, jejunojejunal, or gastrojejunal anastomosis). Of these patients 4 patients had arteriovenous malformations at the anastomotic site, 5 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). One patient had actively bleeding duodenal ulcer at the excluded bulb, which was treated with injection and clip. Conclusions: DBE is a feasible and relatively safe technique to evaluate the small intestines, stomach and biliary tract and associated with reasonably high diagnostic and therapeutic yield in patients with surgically altered bowel anatomy in the setting of bariatric surgery.

Double-balloon enteroscopy in Crohn’s disease: findings and impact on management in a multicenter retrospective study

Double-balloon enteroscopy (DBE) is effective in visualizing the small bowel to perform biopsy sampling and interventions. Few studies have evaluated the utility of DBE in patients with known or suspected Crohn's disease (CD). To evaluate the use of DBE in the diagnosis and impact on patient management in known and suspected CD and to compare capsule endoscopy (CE) with DBE findings. Retrospective study from August 2004 to August 2009 of DBE procedures. Five academic, tertiary U.S. centers. Patients with known or suspected CD. Diagnostic yield, impact on patient management, and comparison of DBE to CE findings in patients with known and suspected CD. We analyzed 98 DBE procedures performed in 81 patients (38 with known CD and 43 with suspected CD). For patients with CD, common indications were abdominal pain and bleeding/anemia. The diagnostic yield was 87% (33/38 patients). The impact on subsequent management decisions was 82% (31/38). Common indications for DBE in patients with suspected CD were abnormal CE or other imaging. The diagnostic yield was 79% (34/43 patients). The impact on subsequent management decisions was 77% (33/43). In 17% of patients (14/81), DBE failed to reach the target lesion. There was 1 perforation, 3 strictures dilated, and 1 of 2 retained capsules recovered. When CE was followed by DBE, 46% of lesions were confirmed on DBE. Retrospective analysis, imperfect criterion standard. DBE is an effective technique for assessment of the small bowel in known and suspected CD and affects management. Failure to reach target areas with DBE is not uncommon, and perforations can occur. There is poor correlation between CE and DBE.

Double‐balloon enteroscopy for choledochojejunal anastomotic stenosis after hepato‐biliary‐pancreatic operation

There have been few reports on the success rate of balloon dilation and stent deployment using endoscopic retrograde cholangiopancreatography by double-balloon enteroscopy (DBE-ERCP) or on the follow-up period after stent removal in patients with a reconstructed digestive tract and stenosis of choledochojejunal anastomosis. The present study was designed to evaluate the usefulness of DBE-ERCP in patients with a reconstructed digestive tract and stenosis of choledochojejunal anastomosis. Forty-four patients with stenosis of choledochojejunal anastomosis underwent DBE-ERCP at Okayama University Hospital between April 2008 and January 2012 (107 procedures). Rates of reaching choledochojejunal anastomosis, stent deployment, and restenosis after stent removal were retrospectively evaluated. Insertion of DBE into the choledochojejunal anastomotic site succeeded in 38 of 44 patients (86.4%), and anastomotic dilation and stent deployment succeeded in 36 of 44 patients (81.8%). In 32 of 44 patients (72.7%), their anastomotic stenoses were improved, and they achieved stent removal. After stent removal, restenosis of choledochojejunal anastomosis was detected in seven of 32 patients; however, the resolution of restenosis was achieved in all seven of those patients. Dilation of choledochojejunal anastomosis combined with stent deployment using DBE-ERCP seems to be a viable first-line treatment for patients with stenosis of choledochojejunal anastomosis.

Utility of double-balloon enteroscopy in patients with left ventricular assist devices and obscure overt gastrointestinal bleeding.

Obscure overt gastrointestinal bleeding (OGIB) is a challenge in patients with left ventricular assist devices (LVADs). We evaluated the utility and safety of double-balloon enteroscopy (DBE) in patients with LVADs in an observational consecutive-patient cohort from a single tertiary referral center. Ten patients with LVADs underwent thirteen DBEs for obscure OGIB. The first OGIB event necessitating DBE occurred after a mean of 512 ± 363 days of LVAD support. All patients underwent DBE, eleven anterograde and two retrograde, with a mean insertion depth 176 ± 85 cm. Diagnostic yield was 69 % with the primary bleeding lesion most frequently found in the mid-bowel. The most common lesions were arteriovenous malformations. Therapeutic yield with argon plasma coagulation (APC), epinephrine injection, and/or hemoclip placement was 89 %. There were no procedure-related complications. DBE in patients with LVADs has good diagnostic yield and high therapeutic yield for obscure OGIB and is safe and well tolerated.

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

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.

A case series of Meckel’s diverticulum: usefulness of double-balloon enteroscopy for diagnosis

BackgroundMeckel’s diverticulum is a congenital anomaly of the gastrointestinal tract. About 98% of affected patients are asymptomatic. Small intestinal examination has become easier since the development of double-balloon enteroscopy. The present case series describes 10 patients with Meckel’s diverticulum in whom double-balloon enteroscopy was useful for diagnosis.Case presentationTen patients (8 men, 2 women) with Meckel’s diverticulum underwent double-balloon enteroscopy at Kobe City Medical Center General Hospital from May 2004 through May 2013. Their median age was 31.5 years (range, 14–83 years). Ten retrograde and two anterograde double-balloon enteroscopy procedures were performed. Double-balloon enteroscopy showed Meckel’s diverticulum in nine patients, but an inverted Meckel’s diverticulum was diagnosed as a lipoma in one patient. Meckel’s diverticulum was detected by iodinated contrast medium during anterograde double-balloon enteroscopy in one of the two patients who underwent this procedure. Meckel’s diverticulum was suspected using capsule endoscopy in one of two patients who underwent this procedure. Abdominal computed tomography was performed in all patients and revealed abnormalities in six, but Meckel’s diverticulum was suspected in only two. Technetium-99 m pertechnetate scintigraphy and a small bowel series were carried out in six patients, revealing Meckel’s diverticulum in one and three patients, respectively. Surgery was performed in eight patients, and endoscopic resection was carried out in one; the remaining patient was transferred to another hospital. Ulcer formation was found in or near Meckel’s diverticulum in eight patients.ConclusionCompared with other modalities, double-balloon enteroscopy is excellent for the diagnosis of Meckel’s diverticulum because direct observation of both Meckel’s diverticulum and ulceration is possible. Double-balloon enteroscopy should be used complementarily to other less invasive examinations when needed to confirm or establish the diagnosis.

The use of double-balloon enteroscopy in retrieving mucosal biopsies from the entire human gastrointestinal tract

Objective. The aim of this explorative study was to evaluate double-balloon enteroscopy (DBE) as a new tool for collecting mucosal biopsies from well-defined parts of the entire small and large bowel in patients with type 2 diabetes and in matched healthy subjects. Material and methods. Twelve subjects with type 2 diabetes and 12 body mass index and age-matched healthy subjects underwent anterograde and retrograde DBE under nurse-administered propofol sedation on two separate days. We attempted to collect two mucosal biopsies from every 30 cm from pylorus to rectum. Results. A mean of 21 biopsy sites were sampled in the diabetic group versus 25 in the healthy group. In 4 out of 24 patients (2 [17%] from each group) sampling from the entire gastrointestinal system was possible. Mean depth of maximal insertion (anterograde) was 478 ± 32 cm in patients with type 2 diabetes versus 465 ± 44 cm in healthy subjects (p = 0.81) and with retrograde access 230 ± 36 cm (type 2 diabetes) versus 207 ± 26 cm (healthy subjects). Conclusions. DBE is a minimally invasive way of collecting fresh biopsies from the entire gastrointestinal tract and, thus provides research and clinical communities with a new possibility to access hitherto unexplored human anatomy and physiology.

PTH-142 Does Double Balloon Enteroscopy Affect Management In Patients With Suspected Small Bowel Tumours? Experience From A Single Tertiary Centre

IntroductionThe advent of small bowel capsule endoscopy (CE) has greatly improved the diagnosis of small bowel tumours. Double balloon enteroscopy (DBE) is the interventional counterpart to CE and has the...

446 Utility of Double Balloon Enteroscopy for the Evaluation of Obscure GI Bleeding in Patients With Roux-en-Y Surgical Anatomy

Overt obscure gastrointestinal bleed (OGIB) poses a unique challenge in patients with altered gastrointestinal anatomy. Potential bleeding sites, such as the excluded stomach or distal jejunojejunal anastomosis are inaccessible in Roux-en-Y anatomy per typical endoscopic tools. Fortunately, balloon-assisted enteroscopy (DBE), provides newfound access these locations, and as such provides a wealth of data as to the etiology these OGIB, as well as how to best treat them. To the best of knowledge, there is no study evaluating the utility of DBE for overt OGIB in patients with Roux-en-Y anatomy.