Outcome and Safety of Anterograde and Retrograde Single-Balloon Enteroscopy: Clinical Experience at a Tertiary Medical Center in Taiwan

Abstract

Single-balloon enteroscopy (SBE) is designed for identifying possible small bowel lesions with balloon-assisted enteroscopy that allows deep intubation of the intestine. However, data regarding the outcome and safety of SBE remain limited. We conducted this study to evaluate the outcome and safety of anterograde and retrograde SBE approaches. This retrospective review from a tertiary medical center in Taiwan included endoscopic reports and chart data from 128 patients with 200 anterograde and retrograde procedures from September 2009 to November 2014. In this study, the most common indication for both anterograde and retrograde SBE was obscure gastrointestinal bleeding (64.4% vs. 60.6%). There were no significant differences between anterograde and retrograde approaches in terms of the diagnostic yield (69.3% vs. 52.5%) and intervention rate (23.8% vs. 17.2%). The procedure time was shorter for anterograde SBE than for retrograde SBE (68.1 ± 23.9 vs. 76.8 ± 27.7 min, P = 0.018). In addition, among the subgroup of patients with obscure gastrointestinal bleeding, the most common etiologies for those in different age-groups were angiodysplasia (≥ 65 years), non-specific ulcers (30–64 years), and Meckel’s diverticulum (< 30 years). The major complication rate during the study was 1.5%; the rate of asymptomatic hyperamylasemia was higher for patients who underwent anterograde SBE than for those who underwent retrograde SBE (13.9% vs. 2%, P = 0.005). The outcome and safety of anterograde and retrograde SBE are similar. However, anterograde SBE has a shorter procedural time and a higher rate of asymptomatic hyperamylasemia.

Hypoxia‐induced intestinal barrier changes in balloon‐assisted enteroscopy

“…Clinically symptomatic bacteraemia is rarely reported in BAE case series (Lin et al 2016;Kim et al 2017), even without routine prophylactic antibiotics. Our study shows, for the first time, objective evidence of bacterial translocation and risk of septic complication in sporadic cases.…”

“…Clinically symptomatic bacteraemia is rarely reported in BAE case series (Lin et al . ; Kim et al . ), even without routine prophylactic antibiotics.…”

“…The reversibility of TER change following reoxygenation suggests that the phenomenon is a physiological process. The reversal of TJ damage and recovery of barrier function by cellular mediators were previously implicated in the mechanism of wound healing, including prostaglandin (Blikslager et al 1999;Little et al 2003 Figure 7. Signalling pathways of MAPK in Caco-2 cells following short-term hypoxia Human Caco-2 cells were exposed to normoxia (Nx) or hypoxia (Hx) for 1 h, and the phosphorylation levels of (A) JNK, (B) p38, (C) ERK-1/2 and (D) IκB in the detergent-soluble fraction were examined by Western blots.…”

“…Various types of nutrients such as flavinoids (Suzuki & Hara, 2009 and short-chain fatty acids (as fermentative products of bacteria) (Fukuda et al 2011;Ploger et al 2012;Machiels et al 2014;Devriese et al 2017) also showed epithelial barrier-fortifying effects. The increase of epithelial barrier integrity associated with TJ protein reorganization by the aforementioned mediators and nutrients is mediated by PI3K and PKCδ signalling pathways (Woo et al 1999;Little et al 2003;Suzuki & Hara, 2009). In studies with endothelial cells, MAPK was involved in claudin-1 phosphorylation and an increase of barrier function (Fujibe et al 2004).…”

Endoscopic Sclerotherapy with a Large Volume of High Concentration of Cyanoacrylate for Jejunal Variceal Bleeding bys Single-Balloon Enteroscopy

“…Other diagnostic modalities such as CT enterography, nuclear scans, and magnetic resonance enterography could improve the diagnosis of small intestinal lesions but not therapy. SBE makes it possible to observe the jejunum, and it can be used for treatment, such as sclerotherapy or cauterization [ 12 , 13 ].…”