The utility of single-balloon enteroscopy for the diagnosis and management of small bowel disorders according to their clinical manifestations: a retrospective review

Abstract

BackgroundThe advent of double-balloon enteroscopy has enabled more accurate diagnosis and treatment of small bowel disorders. Single-balloon enteroscopy permits visualization of the entire small intestine less often than does double-balloon enteroscopy. However, the relative clinical advantages of the 2 methods remain controversial. This study therefore aimed to identify the indications for and therapeutic impact of performing single-balloon enteroscopy.MethodsWe retrospectively reviewed prospectively collected data from adults who underwent single-balloon enteroscopy from January 2007 through November 2011 and analyzed their baseline characteristics, endoscopic findings, pathological diagnoses, and clinical outcomes.ResultsA total of 145 procedures were performed in 116 patients with a mean age of 58.1 ± 17.7 years (range, 18–89 years). The most common indications for performing single-balloon enteroscopy were overt gastrointestinal (GI) bleeding, chronic diarrhea, and occult GI bleeding, accounting for 57.9%, 12.4%, and 9.7% of the patients, respectively. The area of interest was achieved in 80.7% of the cases, with a 5.5% rate of technical failure. An overall positive finding was detected in 65.5% of the cases, of which 33.8% were ulcers and erosions; 8.3%, masses; and 3.4%, angiodysplasia. The diagnostic yields were 42.9%, 52.4%, 78.6%, 50.0%, and 25.0% for patients with overt GI bleeding, occult GI bleeding, abdominal pain, chronic diarrhea, and abnormal imaging results, respectively. Therapeutic procedures were performed in 11% of patients with GI bleeding and achieved a therapeutic yield of 14.6% with a minor complication rate of 11.7%.ConclusionsSingle-balloon enteroscopy was effective for the diagnosis and treatment of small bowel disorders, especially in patients who presented with abdominal pain, GI bleeding, or focal abnormalities on imaging scans.

Jejunal Dieulafoy Lesion Detected by Intraoperative Endoscopy in a Child

“…In a majority of the adult cases, endoscopic hemostasis with balloon-assisted enteroscopy can replace surgery (11)(12)(13), while pediatric patients are usually treated with embolization or surgery (16,17,19). In our case, surgery with intraoperative endoscopy was the last and best treatment option due to failure of identifying the bleeder with balloon-assisted enteroscopy and deteriorated hemodynamics.…”

“…In our case, CT angiography clearly identified the active bleeders by observing the enhancement of contrast media during arterial and delayed phases. Small bowel bleeding could be diagnosed and treated directly with the development of balloon-assisted enteroscopy (11,12). In our case, balloonassisted enteroscopy failed to detect the bleeders due to continual active hemorrhage with massive blood clots retained in the small bowel.…”

“…Adult case series reported successful hemostasis with balloon-assisted enteroscopy in patients with DL of the small bowel (11,12). Dulic-Lakovic et al reported rebleeding in 30% (3/10) of the patients undergoing balloonassisted enteroscopy, with 20% (2/10) eventually needing surgical intervention (11).…”

Risk Factors of Acute Pancreatitis in Oral Double Balloon Enteroscopy

“…In some series on DBE, no complications during or after DBE were reported (19)(20)(21)(22)(23)(24)(25)(26)(27). But reading these articles carefully, one will find in Pata et al (25) 13% oral bleeding, 2% broken tooth and 2% respiratory depression due to aspiration.…”

Success of single-balloon enteroscopy in patients with surgically altered anatomy

“…6,7 The altered anatomy data for spiral enteroscopy have similarly focused on its use in ERCP, [8][9][10] with only one small case series. 10 Although extensive data are available on SBE in patients with native anatomy, [11][12][13][14][15][16][17] the literature on surgically altered anatomy is limited to SBE-assisted ERCP. [18][19][20][21] No study to date has evaluated SBE in patients with altered anatomy outside of ERCP-assisted procedures.…”