Abstract
Background and Study Aims: Even in the era of capsule endoscopy, diseases of the small bowel are sometimes difficult
to diagnose, and endoscopic treatment is not possible without surgical laparotomy.
The new method of carrying out enteroscopy using a double-balloon technique allows
not only diagnostic but also therapeutic endoscopic interventions for lesions in the
small bowel. Preliminary experience with this new method is reported here.
Patients and Methods: Between the end of March 2003 and August 2003, eight patients (four women, four men;
mean age 59 ± 23 years, range 20 - 90) with chronic gastrointestinal bleeding or abdominal
pain, or both, underwent enteroscopy using the double-balloon technique. Seven of
the patients had been suffering from chronic gastrointestinal bleeding for 56 ± 49
months (range 3 - 120 months, median 48 months). The lowest hemoglobin levels ranged
from 3.6 g/dl to 8.6 g/dl (mean 6.7 ± 1.7
g/dl), and a mean of 7.6 ± 5.6 (range 1 - 15) blood units had been transfused. Capsule
endoscopy was carried out in six patients, revealing angiodysplasias in three, suspected
Crohn’s disease in one, fresh blood in the small bowel without a lesion in one, and
a focal enanthema in another patient.
Results: Enteroscopy with the double-balloon technique was carried out using the oral approach
in all patients and additionally with the anal approach in four patients. In two patients
with multiple angiodysplasias, it was possible to examine the whole small bowel and
to treat the angiodysplasias. All of the capsule endoscopy findings were confirmed;
a definite bleeding source was found and treated in two patients with unclear bleeding,
and in another patient the real bleeding source was found (not angiodysplasia). The
enteroscopy system was easy to handle in all cases. No complications occurred. It
was possible to carry out the procedure
with the patients under sedoanalgesia.
Conclusions: This new enteroscopy system is easy to handle and seems to be safe. Visualization
of the whole small bowel is possible using both the oral and anal approaches. Enteroscopy
with the double-balloon technique promises to become a standard method for diagnostic
and therapeutic endoscopy of the small bowel without surgical laparotomy.
