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Endoscopy 2007; 39(7): 613-615
DOI: 10.1055/s-2007-966444
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Complications of double balloon enteroscopy: a multicenter survey

P.  B.  F.  Mensink1 , J.  Haringsma1 , T.  Kucharzik2 , C.  Cellier3 , E.  Pérez-Cuadrado4 , K.  Mönkemüller5 , A.  Gasbarrini6 , A.  J.  Kaffes7 , K.  Nakamura8 , H.  H.  Yen9 , H.  Yamamoto10
  • 1Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center, Rotterdam, The Netherlands
  • 2Department of Medicine B, University of Muenster, Muenster, Germany
  • 3Department of Gastroenterology, Georges Pompidou European Hospital, Paris, France
  • 4Unit of Small Bowel, Section of Digestive Diseases, Hospital General Universitario Morales Meseguer, Murcia, Spain
  • 5Division of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University, Magdeburg University Hospital, Magdeburg, Germany
  • 6Department of Internal Medicine and Endoscopy, Gemelli Hospital, Catholic University, Rome, Italy
  • 7Department of Gastroenterology and Hepatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
  • 8Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  • 9Department of Gastroenterology, Changhua Christian Medical Center, Changhua, Taiwan
  • 10Department of Internal Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Tochigi, Japan
Further Information

Publication History

submitted 11 December 2006

accepted after revision 7 February 2007

Publication Date:
21 May 2007 (online)

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Commentaire de travail de P. B. F. Mensink et al., pp. 613Endoscopy 2007; 39(07): 758-758
DOI: 10.1055/s-0032-1306953

Background and study aims: Double balloon enteroscopy (DBE) is a new technique for the visualization of the small bowel. Although the technique is widely used, little is known about the complications. A few complications have been reported in the literature, mainly in case reports. The aim of this study was to establish the complication rate of both diagnostic and therapeutic DBE. Patients and methods: A total of 10 centers (nine academic centers and one teaching hospital) across four continents participated in the study. Complications were defined according to the literature. A therapeutic DBE was defined as a DBE with use of argon plasma coagulation, a polypectomy snare, injection of fluids (other than ink for marking), removal of foreign body, or balloon dilation. Results: A total 85 adverse events were reported in 2362 DBE procedures. In all, 40 events fulfilled the definition of a complication, 13 in 1728 diagnostic DBE (0.8 %) and 27 during 634 therapeutic procedures (4.3 %). The complications were rated minor in 21 (0.9 %), moderate in 6 (0.3 %) and severe in 13 procedures (0.6 %). No fatal complications were reported. Seven cases of pancreatitis were reported, six after diagnostic (0.3 %) and one after therapeutic (0.2 %) DBE. Conclusions: Diagnostic DBE is safe with a low complication rate. The complication rate of therapeutic DBE is high compared with therapeutic colonoscopy. The reason for this is unclear. The incidence of pancreatitis after DBE is low (0.3 %), but has to be considered in patients with persistent abdominal complaints after a DBE procedure.

References

  • 1 Yamamoto H, Kita H, Sunada K. et al . Clinical outcomes of double-balloon endoscopy for diagnosis and treatment of small intestinal diseases.  Clin Gastroenterol Hepatol. 2004;  2 1010-1016
    CrossrefPubMedSearch in Google Scholar
  • 2 Yamamoto H, Sekine Y, Sato Y. et al . Total enteroscopy with a nonsurgical steerable double-balloon method.  Gastrointest Endosc. 2001;  53 216-220
    Search in Google Scholar
  • 3 May A, Nachbar L, Wardak A. et al . Double-balloon enteroscopy: preliminary experience in patients with obscure gastro-intestinal bleeding or chronic abdominal pain.  Endoscopy. 2003;  35 985-991
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Sun B, Rajan E, Cheng S. et al . Diagnostic yield and therapeutic impact of double-balloon enteroscopy in a large cohort of patients with obscure gastrointestinal bleeding.  Am J Gastroenterol. 2006;  101 1-5
    CrossrefPubMedSearch in Google Scholar
  • 5 Perez-Cuadrado E, Mas P, Hallal H. et al . Double-balloon enteroscopy: a descriptive study of 50 explorations.  Rev Esp Enferm Dig. 2006;  98 73-81
    PubMedSearch in Google Scholar
  • 6 Kaffes A J, Koo J H, Meredith C. Double-balloon enteroscopy in the diagnosis and the management of small-bowel diseases: an initial experience in 40 patients.  Gastrointest Endosc. 2006;  63 81-86
    CrossrefPubMedSearch in Google Scholar
  • 7 Mehdizadeh S, Ross A, Gerson L. et al . What is the learning curve associated with double-balloon enteroscopy? Technical details and early experience in 6 U.S. tertiary care centers.  Gastrointestinal Endosc. 2006;  64 740-750
    CrossrefPubMedSearch in Google Scholar
  • 8 Yen H H, Chen Y Y, Su W W. et al . Intestinal necrosis as a complication of epinephrine injection therapy during double-balloon enteroscopy.  Endoscopy. 2006;  38 542
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Groenen M J, Moreels T G, Orlent H. et al . Acute pancreatitis after double-balloon enteroscopy: an old pathogenetic theory revisited as a result of using a new endoscopic tool.  Endoscopy. 2006;  38 82-85
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Honda K, Mizutani T, Nakamura K. et al . A case of acute pancreatitis probably associated with peroral double-balloon enteroscopy.  World J Gastroenterol. 2006;  12 1802-1804
    PubMedSearch in Google Scholar
  • 11 Honda K, Itaba S, Mizutani T. et al . An increase in the serum amylase level in patients after peroral double-balloon enteroscopy: an association with the development of pancreatitis.  Endoscopy. 2006;  38 1040-1043
    Thieme ConnectPubMedSearch in Google Scholar
  • 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 study.  Endoscopy. 2005;  37 613-616
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Monkemuller K, Weigt J, Treiber G. et al . Diagnostic and therapeutic impact of double-balloon enteroscopy.  Endoscopy. 2006;  38 67-72
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Di Caro S, May A, Heine D GN. et al . The European experience with double-balloon enteroscopy: indications, methodology, safety and clinical impact.  Gastrointest Endosc. 2006;  62 545-550
    PubMedSearch in Google Scholar
  • 15 Cotton P B, Lehman G, Vennes J. et al . Endoscopic sphincterotomy complications and their management: an attempt at consensus.  Gastrointest Endosc. 1991;  37 383-393
    CrossrefPubMedSearch in Google Scholar
  • 16 Mallery J S, Baron T H, Dominitz J A. Standards of Practice Committee: . Complications of ERCP; ASGE Guidelines.  Gastrointest Endosc. 2003;  57 633-638
    CrossrefPubMedSearch in Google Scholar
  • 17 Sieg A, Hachmoeller-Eisenbach U, Eisenbach T. Prospective evaluation of complications in outpatient GI endoscopy: a survey among German gastroenterologists.  Gastrointest Endosc. 2002;  53 620-627
    PubMedSearch in Google Scholar
  • 18 Eckardt V F, Kanzler G, Schnitt T. et al . Complications and adverse effects of colonoscopy with selective sedation.  Gastrointest Endosc. 1999;  49 560-565
    PubMedSearch in Google Scholar
  • 19 Reiertsen O, Skjoto J, Jacobsen C D, Rosseland A R. Complications of fiberoptic gastrointestinal endoscopy - five years’ experience in a central hospital.  Endoscopy. 1987;  19 1-6
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Dafnis G, Ekbom A, Pahlman L, Blomqvist P. Complications of diagnostic and therapeutic colonoscopy within a defined population in Sweden.  Gastrointest Endosc. 2001;  54 302-309
    CrossrefPubMedSearch in Google Scholar
  • 21 Viiala C H, Zimmerman M, Cullen D J, Hoffman N E. Complication rates of colonoscopy in an Australian teaching hospital environment.  Intern Med J. 2003;  33 355-359
    CrossrefPubMedSearch in Google Scholar
  • 22 Rathgaber S, Wick T. Colonoscopy completion and complication rates in a community gastroenterology practice.  Gastrointest Endosc. 2006;  64 556-562
    CrossrefPubMedSearch in Google Scholar

P. B. F. Mensink, MD, PhD

Erasmus MC - University Medical Center
Department of Gastroenterology and Hepatology

Dr. Molewaterplein 40
3015 GD Rotterdam
The Netherlands

Fax: +31-10-4634680

Email: p.mensink@erasmusmc.nl