Spiral enteroscopy with the new DSB overtube: a novel technique for deep peroral small-bowel intubation

Akerman, Paul A.; Agrawal, Deepak; Cantero, Daniel; Pangtay, Jesus

doi:10.1055/s-0028-1103402

Cited by 174 publications

(154 citation statements)

References 23 publications

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“…A single balloon enteroscope and a spiral overtube enteroscope have been recently developed. Single-balloon enteroscopy performance and diagnostic yield was comparable to DBE, whereas spiral enteroscopy showed a reduction in the examination time (22)(23)(24)(25)(26).…”

Section: Introductionmentioning

confidence: 89%

Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding?

Monsanto¹,

Almeida²,

Lérias³

et al. 2012

Rev. esp. enferm. dig.

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Background: in 21st century, endoscopic study of the small intestine has undergone a revolution with capsule endoscopy and balloon-assisted enteroscopy. The difficulties and morbidity associated with intraoperative enteroscopy, the gold-standard in the 20 th century, made this technique to be relegated to a second level. Aims: evaluate the actual role and assess the diagnostic and therapeutic value of intraoperative enteroscopy in patients with obscure gastrointestinal bleeding.Patients and methods: we conducted a retrospective study of 19 patients (11 males; mean age: 66.5 ± 15.3 years) submitted to 21 IOE procedures for obscure GI bleeding. Capsule endoscopy and double balloon enteroscopy had been performed in 10 and 5 patients, respectively.Results: with intraoperative enteroscopy a small bowel bleeding lesion was identified in 79% of patients and a gastrointestinal bleeding lesion in 94%. Small bowel findings included: angiodysplasia (n = 6), ulcers (n = 4), small bowel Dieulafoy's lesion (n = 2), bleeding from anastomotic vessels (n = 1), multiple cavernous hemangiomas (n = 1) and bleeding ectopic jejunal varices (n = 1). Agreement between capsule endoscopy and intraoperative enteroscopy was 70%. Endoscopic and/or surgical treatment was used in 77.8% of the patients with a positive finding on intraoperative enteroscopy, with a rebleeding rate of 21.4% in a mean 21-month follow-up period. Procedure-related mortality and postoperative complications have been 5 and 21%, respectively.Conclusions: intraoperative enteroscopy remains a valuable tool in selected patients with obscure GI bleeding, achieving a high diagnostic yield and allowing an endoscopic and/or surgical treatment in most of them. However, as an invasive procedure with relevant mortality and morbidity, a precise indication for its use is indispensable.

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Section: Introductionmentioning

confidence: 89%

Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding?

Monsanto¹,

Almeida²,

Lérias³

et al. 2012

Rev. esp. enferm. dig.

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“…Deep enteroscopy, on the other hand, allows direct endoscopic visualization and control, as well as most diagnostic and therapeutic endoscopic techniques. The concept of deep 2 Soon, single-balloon enteroscopy 3 (SBE) and spiral enteroscopy 4 (SE) were also introduced. These techniques are grouped under the designation of device-assisted enteroscopy (DAE).…”

Section: Introductionmentioning

confidence: 99%

Multicenter survey on the use of device‐assisted enteroscopy in Portugal

et al. 2016

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Background: Device-assisted enteroscopies (DAEs) are recent endoscopic techniques that enable direct endoscopic smallbowel evaluation. Objective: The objective of this article is to evaluate the implementation of DAEs in Portugal and assess the main indications, diagnoses, diagnostic yield, therapeutic yield and complication rate. Methods: We conducted a multicenter retrospective series using a national Web-based survey on behalf of the Portuguese Small-Bowel Study Group. Participants were asked to fill out two online databases regarding procedural data, indications, diagnoses, endoscopic therapy and complications using prospectively collected institutional data records. Results: A total of eight centers were enrolled in the survey, corresponding to 1411 DAEs. The most frequent indications were obscure gastrointestinal bleeding (OGIB), inflammatory bowel disease and small-bowel tumors. The pooled diagnostic yield was 63%. A relation between the diagnostic yield and the indications was clear, with a diagnostic yield for OGIB of 69% (p ¼ 0.02) with a 52% therapeutic yield. Complications occurred in 1.2%, with a major complication rate of 0.57%. Perforations occurred in four patients (0.28%). Conclusion: DAEs are safe and effective procedures, with complication rates of 1.2%, the most serious of which is perforation. Most procedures are performed in the setting of OGIB. Diagnostic and therapeutic yields are dependent on the indication, hence appropriate patient selection is crucial.

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“…Inclusion of these methods in the endoscopy armamentarium introduced a revival of small bowel investigation and allowed an exponential accrual of our knowledge about small intestine diseases. Single balloon enteroscopy or spiral enteroscopy were introduced as alternatives to double balloon enteroscopy over the past few years (3,84), but their value in NSAID-induced enteropathy diagnostics is still to be determined.…”

Section: Standard Enteroscopy Methodsmentioning

confidence: 99%

Non-steroidal Anti-inflammatory Drug Induced Injury to the Small Intestine

Tachecí

Kopáčová

Rejchrt

et al. 2010

Acta Med. (Hradec Kralove, Czech Repub.)

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Non-steroidal anti-inflammatory drugs (NSAIDs) represent the group of most commonly used drugs worldwide. The target group for use of NSAIDs comprises the elderly population with higher morbidity and mortality and a higher risk of drug toxicity (91). This fact together with the aging of the population in developed countries means increasing medical and economical problems in this context. In a large prospective analysis of adverse drug reactions in 18,820 patients in the United Kingdom, NSAIDs were responsible for 1.9 % (363) of all hospital admissions (29.6 % of all drug-related adverse events) in the period of time studied (67). The most frequent were gastrointestinal, nervous system, renal, and allergic adverse effects. Gastrointestinal toxicity is widely recognised, especially in the gastroduodenal area.Over the past decade, an increasing quantity of data has been gathered documenting small bowel involvement and its importance, showing its previous underestimation. This is related to advancements in small bowel evaluation, especially in small bowel endoscopy. The goal of this review is to discuss current knowledge of the range of NSAID-induced small intestinal injury, its clinical features, diagnosis and management. HistoryThe first description of NSAID (aspirin)-induced gastropathy identified by endoscope was presented by Douthwaite and Lintott in 1938 (22). Small bowel damage due to indomethacin management was observed for the first time in humans in the 70s (80). Many cases of small bowel perforation (65) and other clinical manifestations of small bowel enteropathy were published (7,8,9,10,11,12,56) in the 80s. Most morphology data were acquired from autopsy (4) and surgical studies at that time (57). Because of the relative inaccessibility of the small intestine, initial endoscopy data were drawn from sonde enteroscopy, and were not published until the early 90s (64). The capsule endoscopy era begins in the year 2000 (44) and is linked with an information boom concerning NSAID-induced enteropathy. EpidemiologyAccording to the data published in the ARAMIS (Arthritis, Rheumatism, and Aging Medical Information System) database, up to 1.3 % of patients treated with NSAIDs are hospitalised for severe gastrointestinal complications in the USA and Canada, a 1-year mortality rate is seen in about 0.11-0.22 % in this population (75). Summary: Non-steroidal anti-inflammatory drug (NSAIDs) induced enteropathy represents an important complication of one of the most commonly used drugs worldwide. Due to previous diagnostics difficulties the real prevalence of this disease was underestimated for a long time. The pathogenesis of NSAID-enteropathy is more multifactorial and complex than formerly assumed but has still not been fully uncovered. A combination of the local and systemic effect plays an important role in pathogenesis. Thanks to novel enteroscopy methods (wireless capsule endoscopy, double balloon enteroscopy), small bowel lesions are described in a substantial section of NSAID users although most are clinical...

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Spiral enteroscopy with the new DSB overtube: a novel technique for deep peroral small-bowel intubation

Abstract: The new DSB is a means of rapid, safe, and effective deep small-bowel intubation. Depth of insertion into the small bowel and total procedure time compare favorably with other deep enteroscopy techniques. The DSB performed equally well with both enteroscopes.

Cited by 174 publications

References 23 publications

Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding?

Is there still a role for intraoperative enteroscopy in patients with obscure gastrointestinal bleeding?

Multicenter survey on the use of device‐assisted enteroscopy in Portugal

Non-steroidal Anti-inflammatory Drug Induced Injury to the Small Intestine

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