Push-and-Pull Enteroscopy Using a Single-Balloon Technique for Difficult Colonoscopy

Background and Study Aims: Several factors predict difficult or incomplete colonoscopy with a standard colonoscope, including female gender, low body mass index, extensive diverticulosis, and prior pelvic surgery.
Patients and Methods: A push-and-pull enteroscopy device and a single-balloon technique was used in 14 patients (six men, eight women; mean age 62 ± 15 years) after failure of ileocolonoscopy or endoscopic therapy using either a standard or a pediatric colonoscope. The original ileocolonoscopy had been performed to investigate colon polyps (n = 6), an obscure inflammatory process in the ileocecal region (n = 6), or iron deficiency anemia with a positive fecal occult stool test (n = 2).
Results: Ileocolonoscopy was successfully performed using this push-and-pull technique in all 14 patients without technical problems or complications. All the endoscopic therapeutic interventions that were required were also performed without complications, with the exception of one instance of bleeding. Multiple polyps were found in six patients; a colon cancer was found in one patient; appendicitis combined with a carcinoid tumour of the appendix was diagnosed in one patient; ileocolitis was observed in two patients; one patient with Crohn’s disease had stenoses in the region of an anastomosis; and in three patients no relevant pathological finding was seen.
Conclusion: It was possible to perform ileocolonoscopy with therapeutic interventions using this new thin push-and-pull enteroscopy device with a single-balloon technique in patients who had previously undergone incomplete colonoscopy using a standard colonoscope.

References

• 1 Waye J D, Bashkoff E. Total colonoscopy: is it always possible?.  Gastrointest Endosc. 1991;  37 152-154
• 2 Marshall J B, Barthel J S. The frequency of total colonoscopy and terminal ileal intubation in the 1990s.  Gastrointest Endosc. 1993;  39 518-520
• 3 Anderson J C, Gonzalez J D, Messina C R, Pollack B J. Factors that predict incomplete colonoscopy: thinner is not always better.  Am J Gastroenterol. 2000;  95 2784-2787
• 4 Anderson J C, Messina C R, Cohn W. et al . Factors predictive of difficult colonoscopy.  Gastrointest Endosc. 2001;  54 558-562
• 5 Takahashi Y, Tanaka H, Kinjo M, Sakumoto K. Prospective evaluation of factors predicting difficulty and pain during sedation-free colonoscopy.  Dis Colon Rectum. 2005;  48 1295-1300
• 6 Hull T, Church J M. Colonoscopy: how difficult, how painful?.  Surg Endosc. 1994;  8 784-787
• 7 Marshall J B, Perez R A, Madsen R W. Usefulness of a pediatric colonoscope for routine colonoscopy in women who have undergone hysterectomy.  Gastrointest Endosc. 2002;  55 838-841
• 8 Kaffes A J, Mishra A, Ding S L. et al . A prospective trial of variable stiffness pediatric vs. standard instrument colonoscopy.  Gastrointest Endosc. 2003;  58 685-689
• 9 Yamamoto H, Kita H, Sunada K. et al . Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases.  Clin Gastroenterol Hepatol. 2004;  2 1010-1016
• 10 May A, Nachbar L, Wardak A. et al . Double-balloon enteroscopy: preliminary experience in patients with obscure gastrointestinal bleeding or chronic abdominal pain.  Endoscopy. 2003;  35 985-991
• 11 May A, Nachbar L, Schneider M, Ell C. Double-balloon enteroscopy (push-and-pull enteroscopy) of the small bowel: feasibility, diagnostic and therapeutic yield in patients with suspected small bowel disease.  Gastrointest Endosc. 2005;  62 62-70
• 12 Ell C, May A, Nachbar L. et al . Push-and-pull enteroscopy in the small bowel using the double-balloon technique: results of a prospective European multicenter trial.  Endoscopy. 2005;  37 613-616
• 13 Saifuddin T, Trivedi M, King P D. et al . Usefulness of a pediatric colonoscope for colonoscopy in adults.  Gastrointest Endosc. 2000;  51 314-317
• 14 Fruhmorgen P, Demling L. Complications of diagnostic and therapeutic colonoscopy in the Federal Republic of Germany: results of an inquiry.  Endoscopy. 1979;  11 146-150
• 15 Dickey W. Does fluoroscopic imaging still have a role in colonoscopy?.  J Clin Gastroenterol. 2004;  38 676-679
• 16 Lichtenstein G R, Park P D, Long W B. et al . Use of push enteroscope improves ability to perform total colonosocpy in previously unsuccessful attempts at colonoscopy in adult patients.  Am J Gastroenterol. 1999;  94 187-190
• 17 Al Shurieki SH, Marshall J B. Is the variable stiffness paediatric colonoscope more effective than a standard adult colonoscope for outpatient adult colonoscopy? A randomised controlled trial.  Dig Liver Dis. 2005;  37 698-704
• 18 Yamamoto H, Kita H, Sunada K. et al . Colonoscopy using a double-balloon endoscope for technical difficult cases.  Endoscopy. 2005;  37 (Suppl 1) A53