Double balloon endoscopy associated pancreatitis: A description of six cases

Abstract

INTRODUCTIONSince its introduction in 2001 by Yamamoto [1] , double balloon endoscopy (DBE) has revolutionized both diagnostic and therapeutic small bowel endoscopy [2] . This technique allows (intervention) endoscopy of the complete small bowel (often in two sessions) with the possibility of carrying out interventions; e.g. mucosal biopsy, argon plasma coagulation, snare polypectomy, injection therapy, tattooing, foreign body extraction and balloon dilatation. DBE plays an important role in the diagnosis and treatment of obscure gastrointestinal bleeding [3][4][5][6] , Crohn's disease [7][8][9][10] , celiac disease [11,12] , polyposis syndromes [13] and small bowel tumors. In the series published to date, complications solely related to the diagnostic procedure are rare [14][15][16][17][18] . A recent retrospective multicenter survey indicates a complication rate of 0.8% in diagnostic procedures [16] . In that study, pancreatitis occurred in six of 2362 (0.3%) procedures and contributed to 46% of all complications after diagnostic DBE. Another recent study showed that an asymptomatic rise of serum amylase and lipase levels after antegrade DBE is frequently encountered [19] . Nevertheless, only a few patients develop the clinical picture of post-DBE pancreatitis. The reason for this remains unknown.This article presents an analysis of all DBE-related cases of pancreatitis identified prospectively from a recorded DBE-complication database of 603 procedures in a single center. RESULTS: This is the largest single-center study reporting on post-DBE pancreatitis prospectively. Six patients (1.0%) developed post-DBE pancreatitis, all after antegrade DBE. There was no association with gender, duration of the procedure or type of endoscope. The mean age was 51.9 years (range 25-78). Four patients had severe pancreatitis. Of these, two had inflammatory signs in the body-tail region, one had pancreatitis in the tail region, and the total pancreas was involved in one. MATERIALS AND METHODS From CONCLUSION:The incidence of post-DBE pancreatitis in our series is higher than previously reported. We found no relation with DBE-endoscope type. The inflammatory changes occurred in the body-tail region of the pancreas, suggesting that post-DBE pancreatitis is caused by repetitive mechanical strain on the pancreas.

Role of small-bowel endoscopy in the management of patients with inflammatory bowel disease: an international OMED–ECCO consensus

“…Diagnostic DBE is accompanied by complications in < 1 % of cases. Hyperamylasaemia has been documented in up to 50 % of patients [157], but clinically significant pancreatitis occurs in only 1 %, almost exclusively after use of the oral insertion route [158,159]. Therapeutic balloon enteroscopy with balloon dilation of strictures has a reported perforation risk of 0 % -3 %, which is comparable to dilation of colonic Crohnʼs strictures [160,161].…”

Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach

“…In the series published to date, complications of DBE solely relating to the diagnostic procedure are rare. A recent retrospective multicenter survey in four countries has indicated a complication rate of 0.8% (13/1728) in diagnostic procedures and 4.3% (27/634) for therapeutic DBE, and there were no fatal cases [63,84,85] . During DBE, careful attention must be paid not to insufflate too much air, because this induces intestinal loop formation and impedes deep advancement [73] .…”

Enteroscopy

“…[39][40][41][42][43][44][45][46][47][48][49][50] Two large studies have reported on the complications associated DBE. 40,41 A large, multicenter international complication survey was presented by Mensink et al 40 A total of 10 centres across four continents were participated in the study and reported on a total of 40 complications in 2362 DBE procedures, 13 in 1728 diagnostic DBE (0.8%), and 27 during 634 therapeutic procedures (4.3%).…”