ENDOSCOPIC RETROGRADE DESINVAGINATION WITH DOUBLE BALLOON ENTEROSCOPE: A NEW ENDOSCOPY TREATMENT FOR SMALL BOWEL

Introduction:

Symptomatic intussusception of a long ileal segment in the colon has surgical treatment. Large-channel double balloon enteroscopy (DBE) (3.2 mm) is providing new therapeutic solutions.

Case report:

During a colonoscopy in a 42-year-old patient with rectal bleeding and symptoms of subocclusion, an invaginated mass was identified through Bahuin. A DBE (via anal) identified the head of the same (large polyp) by cecal retroversion. After optimal positioning aligned with terminal ileum, the invaginated segment is reintroduced, pushing the lesion with the distal end of the enteroscope with inflated balloon, locating its implantation site at 60 cm from Bahuin but without identifying pedicle. With the enteroscope proximal to the lesion and its balloon inflated, then we retracting the lesion until its clear exposure (semipediculate very wide) and perform adrenaline infiltration for mucosal resection. The lesion was removed and schar closed with clips with tatoo of this site. The control with capsule of the asymptomatic patient shows the tattoo and eschar in good condition 70 minutes before Bahuin orifice.

Comments:

The lesion should not be removed from the colon by: 1) possibility of perforation of the invaginated serosa and 2) after polypectomy the lesion could return to its implantation origin site, leaving the eschar outside the scope of the treatment (almost always necessary). The scheme of this new technical variant is presented. First description of disinvagination and treatment of its cause in ileum by EDB by VA. Inflation/deflation of both balloons has been shown to be useful for optimal positioning and reduction of intussusception. We have only found an anterograde disinvagination in small bowel in the jejunum (Yamamoto H et al (Gastrointest Endosc 2004), but no retrograde cases treatment with DBE are performed.