Safer endoscopic therapy of small-bowel diseases during double-balloon enteroscopy

Clockwise insertion: A risk factor of pancreatic hyperamylasemia and acute pancreatitis after peroral balloon‐assisted enteroscopy

“…Although various theories have been postulated for post‐BAE acute pancreatitis, we have reported one plausible mechanism based on the pancreatitis site . Post‐BAE acute pancreatitis was mostly localized to the pancreas body and/or tail, as in the patients of Tsujikawa et al We also encountered one patient with post‐DBE severe pancreatitis in the pancreas tail after clockwise insertion (Table ).…”

“…Although balloon‐assisted enteroscopy (BAE), SBE and DBE, is a safe procedure without major complications, we, Tsujikawa et al, and others have experienced acute pancreatitis after peroral BAE. Although various theories have been postulated for post‐BAE acute pancreatitis, we have reported one plausible mechanism based on the pancreatitis site . Post‐BAE acute pancreatitis was mostly localized to the pancreas body and/or tail, as in the patients of Tsujikawa et al We also encountered one patient with post‐DBE severe pancreatitis in the pancreas tail after clockwise insertion (Table ).…”

“…Because the duodenum is markedly shortened, and is straight from the pyloric ring to the ligament of Treitz during peroral BAE, we have suspected that post‐BAE acute pancreatitis would occur as a result from the severe mechanical strain with traumatic injury and/or ischemia on the pancreas body and/or tail, especially in clockwise insertion (Fig. ).…”

“…). To reduce the prolonged mechanical strain, we nowadays gently perform DBE, especially in clockwise insertion, resulting in decreased incidence of pancreatic hyperamylasemia and acute pancreatitis (Table ). We therefore believe that clockwise insertion is a significant risk factor of pancreatic hyperamylasemia and acute pancreatitis after BAE, both SBE and DBE.…”

Effective Endoscope for Endoscopic Retrograde Cholangiopancreatography in Patients with Roux-en-Y Anastomosis: A Single-, Double-, or “Short” Double-Balloon Enteroscope?

“…When the papilla or the choledochoenterostomy site is reached, selective cannulation and therapeutic procedures are also difficult. With the recent advent of balloon-assisted enteroscopy, the SEB and DBE can visualize the entire small bowel via either the peroral and/or peranal approach, and provide high diagnostic yields and therapeutic capabilities [7,8]. These enteroscopes permit examinations of a much longer segment of the small bowel than does a standard endoscope, and can be applied to ERCP in patients with Roux-en-Y anastomosis [2-4, 6, 9].…”