Small Bowel Endoscopy Using the Double-Balloon Technique: Four-Year Results in a Tertiary Referral Hospital in Brazil

Abstract

Background: Double-balloon enteroscopy (DBE) allows evaluation and therapy for various small bowel diseases. In this series the outcome of a 4-year experience in a tertiary hospital school in Brazil is reported. Methods: A total of 457 consecutive DBE were performed in 418 patients from August 2004 to August 2008. 93 patients with several indications, whose aim was not the evaluation of suspected diseases of the small bowel mucosa, were excluded, therefore leaving 364 DBE in 325 patients for analysis. Data were retrospectively collected with regard to clinical, endoscopic findings, therapy and complications. Results: Among the 364 DBE performed in 325 patients, 143/325 were males (44%) and 182/325 females (56%) with a mean age of 48.6 ± 15.7 years (range 17–89). Mean investigation time was 64 ± 22 min (range 35–135). The depth of insertion beyond the ligament of Treitz was 230 ± 85 cm (range 30–500) by the antegrade approach and 140 ± 75 cm (range 0–320) by the retrograde approach. Total enteroscopy was achieved in 41.66% of the attempts (30 of 72 patients). Overall diagnostic yield was 54.95% (200 of 364 procedures) ranging from 0 to 100% in this series, depending on the indication. Angiodysplasia was the main diagnosis in 24.5% (49 of 200 procedures) and endoscopic treatment, including biopsies, hemostasis, tattooing and polypectomy were performed in 65.38% (238 of 364 procedures). No major complications were reported. Conclusions: DBE is a feasible, safe and well-tolerated procedure allowing endoscopic therapy. Selection of indications increases its diagnostic yield.

SINGLE-01: a randomized, controlled trial comparing the efficacy and depth of insertion of single- and double-balloon enteroscopy by using a novel method to determine insertion depth

“…In a Japanese cohort using DBE, complete enteroscopy was achieved in 86%. 15 Early Western series report total enteroscopy rates between 0% 13 and 42%, 16 and mostly less than 20%. 3,4,17 However, one recent study from Europe reported more favorable results, which may suggest a learning curve effect.…”

Double‐balloon endoscopy in clinical practice: Where are we now?

“…To date, OGIB has been the most frequent clinical indication for DBE and accounts for 50–70% of all examinations performed 3,15–20,26,41,42 …”

“…With regard to DBE findings, vascular lesions are discovered more frequently in Western patients, 3,12–19 whereas inflammatory changes and/or tumors are found more frequently in Japanese patients 15,20–22 . Although there is no clear‐cut explanation for this phenomenon, differences in the age and selection of patients could play a role, as Eastern DBE patients are younger and Japanese patients more often undergo the procedure for abdominal pain/occlusion or suspected small bowel tumors 13,20–22 .…”

The SURMetaGIT study: Design and rationale for a prospective pan-omics examination of the gastrointestinal response to Roux-en-Y gastric bypass surgery

“…55 In our centre, no major complications have been reported for 364 DBE procedures, 112 of which included biopsy collection. 56…”

“…55 In our centre, no major complications have been reported for 364 DBE procedures, 112 of which included biopsy collection. 56 The amount of GI tissue obtained from the pre-and postoperative biopsies in this study was sufficient for gene expression analysis for all enrolled patients. However, the excluded stomach portion was inaccessible for postoperative biopsy sample collection in some patients because of stenosis in the biliopancreatic limb (n ¼ 3) and the difficulty of reaching this portion of the GI tract (n ¼ 10).…”