Consensus report of the 2nd International Conference on Double Balloon Endoscopy

Interventional balloon-enteroscopy

“…14 It seems to be reasonable to perform DBE immediately if therapeutic interventions are probable, especially in case of severe and persistent bleeding from the small bowel. 15 Vascular lesions and preferably angiectasias are the most frequent finding in small bowel bleeding and an important indication for therapeutic BE. 16 Argon plasma coagulation (APC) is most often used to stop active bleeding and to prevent future bleeding episodes from angiectasias ( Fig.…”

Risk Factors of Acute Pancreatitis in Oral Double Balloon Enteroscopy

“…Intravenous crystaloids are administered during DBE. Conscious sedation is thought to be sufficient for DBE (5,6). It seems to be much better in DBE in comparison with general anaesthesia according to our experience.…”

“…There are many hypotheses explaining this fact: direct trauma of the pancreas caused by the pressure of an endoscope against the vertebral column, the disorders in microcirculation during the procedure, increase in intraluminal duodenal pressure during enteroscopy caused by inflation of the two balloons, reflux of duodenal fluids into the pancreatic duct, timing of the procedure and others. We published a prospective study concerning this risk (Kopáčová et al Gastrointest Endosc 2007; 66 (6): 1133-1138) (4). In our contemporary project we continue in priority investigation of known or supposed protective and risk factors (rehydration, oral DBE, time of procedure, number of cycles, the depth of intubation, CO 2 insufflation) in correlation with serum and urine amylase, lipase and hs-CRP and some possible plasmatic markers of a higher risk of acute pancreatitis (malondialdehyde, procalcitonin, S 100 proteins, cathepsin B, pancreatic secretory trypsin inhibitor (PSTI; also known as serine protease inhibitor Kazal-type 1 (SPINK 1) or tumour-associated trypsin inhibitor (TATI), lactoferrin, E-selectin and alfa-1 antitrypsin (A1AT).…”

“…Carbon dioxide (CO 2 ), unlike air, is rapidly absorbed from the bowel. Bowel insufflation with CO 2 , instead of air, enhances patients comfort and decreases the need for sedation (5)(6)(7). We have used CO 2 insufflation in DBE procedures regularly since 2007; since we had no complications with hyperinflation, the comfort of the patient rapidly increased and this type of insufflation is helpful for easier and deeper insertion of the scope, because the absorption of CO 2 is 150-times faster than absorption of air in the bowel.…”

“…During withdrawal of the endoscope and during therapeutic interventions, spasmolytics might improve visualisation of the small-bowel mucosa by reducing motility of the small bowel (5,6).…”