A retrospective analysis of emergency double-balloon enteroscopy for small-bowel bleeding

Abstract

Although the role of emergency esophagogastroduodenoscopy (EGD) and colonoscopy for upper and lower gastrointestinal bleeding (GIB) is well defined, there are no data on the concept of emergency double-balloon enteroscopy (DBE) for small-bowel bleeding. The aim of this study was to retrospectively evaluate the concept of emergency DBE in overt obscure GIB and assess its impact on patient management. A total of 17 emergency DBEs for overt obscure GIB were carried out in ten patients (six women, four men; mean age 68 years, range 35 - 83). The following diagnoses were made: actively bleeding Dieulafoy lesions of the small bowel, n = 2; bleeding tumors, n = 4 (carcinoids n = 2, adenocarcinoma n = 1, lipoma n = 1); bleeding angiodysplasias and/or large arteriovenous malformation (AVM), n = 2; multiple ulcers, n = 1; and no diagnosis, n = 1. Endoscopic therapies included argon plasma coagulation (n = 6), injection of epinephrine (n = 3), and use of fibrin glue (n = 1). It appears that emergency DBE is technically feasible, facilitates both diagnosis and therapy and enables management of patients with massive overt obscure GIB. This study is a first step in establishing the concept of emergency DBE for patients with suspected small-bowel bleeding.

Therapeutic Double-Balloon Enteroscopy: A Binational, Three-Center Experience

“…DBE is a relatively recent endoscopic modality, which enables high-resolution imaging of the entire small bowel, allowing interventional endotherapy such as hemostasis, snare polypectomy, pneumatic balloon stricture dilation, and stent placement, among others [3,5,11,12,13,14,15,16]. It is quite clear that this technology has a direct therapeutic advantage over other investigational methods such as capsule endoscopy or magnetic resonance imaging enteroclysis.…”

“…Capsule endoscopy and device-assisted enteroscopy (DAE) using balloon and spiral methods have increased our ability to investigate the small bowel [1,2,3,4,5]. The increased use of these devices has been paralleled with the discovery of conditions that can be treated endoscopically.…”

Therapeutic and interventional endoscopy for gastrointestinal bleeding

“…In our opinion, a true emergent BAE should be performed within 24 h and preferably 12 h after patient presentation [27].…”

“…Device assisted-enteroscopy techniques such as doubleballoon enteroscopy (DBE) and single-balloon enteroscopy (SBE), as well as spiral enteroscopy (SE), have replaced push enteroscopy as the methods of choice to perform deep, small bowel investigation and to perform endoscopic interventions within the small intestine [26,27].…”

Sangrado del intestino delgado: enfoque y tratamiento

“…El examen de todo el ID se logra en el 16% al 86% de los casos (60). En sangrados agudos, ha demostrado que es un procedimiento útil, con una menor tasa de sangrados recurrentes (61). Las complicaciones menores se presentan en el 9,1% de los pacientes e incluyen distensión o dolor abdominal, odinofagia y náuseas.…”