Endoscopy 2006; 38(1): 42-48
DOI: 10.1055/s-2005-921188
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Double-Balloon Enteroscopy: Indications, Diagnostic Yield, and Complications in a Series of 275 Patients with Suspected Small-Bowel Disease

G.  D.  N.  Heine1 , M.  Hadithi1 , M.  J.  M.  Groenen2 , E.  J.  Kuipers2 , M.  A.  J.  M.  Jacobs1 , C.  J.  J.  Mulder1
  • 1Dept. of Gastroenterology, Medical Center, Free University of Amsterdam, The Netherlands
  • 2Dept. of Gastroenterology and Hepatology, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands
Further Information

Publication History

Submitted 22 July 2005

Accepted after revision 12 November 2005

Publication Date:
23 January 2006 (online)

Background and Study Aims: Until recently, only the proximal small bowel was accessible for diagnostic and therapeutic endoscopy. This paper describes experience in the first 275 patients examined and treated with the new method of double-balloon enteroscopy (DBE), which is expected to make full-length enteroscopy possible.
Patients and Methods: Between November 2003 and May 2005, double-balloon enteroscopy was conducted in 275 consecutive patients presenting at two tertiary referral hospitals. The characteristics of the patients, indications for the procedures, procedural parameters, and diagnostic yield are described here. All conventional treatment options were available. The tolerability of the procedure was assessed in a small subset of the patients. After the procedure, the patients were monitored in a recovery room for at least 2h. They were discharged afterwards, provided there were no signs of complications or complaints.
Results: The main indication for DBE was suspected small-bowel bleeding (n = 168), and the lesions responsible for the bleeding were found in 123 patients (73 %) and treated in 61 (55 %). In patients with refractory celiac disease (n = 25), DBE revealed a high proportion (six patients, 23 %) of enteropathy-associated T-cell lymphomas that had not been suspected on other tests. Further DBE indications were surveillance and treatment of hereditary polyposis syndromes (n = 20); and suspected Crohn’s disease, which was diagnosed with DBE in four of 13 patients (30 %). No relevant pathology was found in 24 % of the patients. Panenteroscopy was successfully performed in 26 of 62 patients (42 %) in whom it was attempted, in either one or two sessions. The average duration of the procedures was 90 min (range 30 - 180 min, SD 42), and the average insertion length was 270 cm (range 60 - 600 cm, SD 104). Patients’ tolerance of the procedure was excellent. Severe complications were recognized in three cases (1 %), all involving pancreatitis.
Conclusions: This large pilot series shows that DBE is a well-tolerated and safe new endoscopic technique with a high diagnostic yield in selected patients.

References

  • 1 Taylor A C, Buttigieg R J, McDonald I G, Desmond P V. Prospective assessment of the diagnostic and therapeutic impact of small-bowel push enteroscopy.  Endoscopy. 2003;  35 951-956
  • 2 Lewis B S. The history of enteroscopy.  Gastrointest Endosc Clin N Am. 1999;  9 1-11
  • 3 Bouhnik Y, Bitoun A, Coffin B. et al . Two way push videoenteroscopy in investigation of small bowel disease.  Gut. 1998;  43 280-284
  • 4 Kopacova M, Bures J, Rejchrt S. et al . Intraoperative enteroscopy: personal experience from 1995 to 2002; in Czech.  Cas Lek Cesk. 2003;  142 303-306
  • 5 Mata A, Bordas J M, Feu F. et al . Wireless capsule endoscopy in patients with obscure gastrointestinal bleeding: a comparative study with push enteroscopy.  Aliment Pharmacol Ther. 2004;  20 189-194
  • 6 Barkin J S, Chong J, Reiner D K. First-generation video enteroscope: fourth-generation push-type small bowel enteroscopy utilizing an overtube.  Gastrointest Endosc. 1994;  40 743-747
  • 7 Lin S, Branch M S, Shetzline M. The importance of indication in the diagnostic value of push enteroscopy.  Endoscopy. 2003;  35 315-321
  • 8 Lewis B S. Small-bowel enteroscopy.  Lancet. 1991;  337 1093-1094
  • 9 Jensen D M. Current diagnosis and treatment of severe obscure GI hemorrhage.  Gastrointest Endosc. 2003;  58 256-266
  • 10 Belaiche J, Van Kemseke C, Louis E. Use of the enteroscope for colo-ileoscopy: low yield in unexplained lower gastrointestinal bleeding.  Endoscopy. 1999;  31 298-301
  • 11 Ell C, May A. Capsule status 2004: what is the outcome in bleeding? Are there really additional indications?.  Endoscopy. 2004;  36 1107-1108
  • 12 Delvaux M, Fassler I, Gay G. Clinical usefulness of the endoscopic video capsule as the initial intestinal investigation in patients with obscure digestive bleeding: validation of a diagnostic strategy based on the patient outcome after 12 months.  Endoscopy. 2004;  36 1067-1073
  • 13 Saurin J C, Delvaux M, Vahedi K. et al . Clinical impact of capsule endoscopy compared to push enteroscopy: 1-year follow-up study.  Endoscopy. 2005;  37 318-323
  • 14 Yamamoto H, Sekine Y, Sato Y. et al . Total enteroscopy with a nonsurgical steerable double-balloon method.  Gastrointest Endosc. 2001;  53 216-220
  • 15 Yamamoto H, Sugano K. A new method of enteroscopy: the double-balloon method.  Can J Gastroenterol. 2003;  17 273-274
  • 16 Yamamoto H, Yano T, Kita H. et al . New system of double-balloon enteroscopy for diagnosis and treatment of small intestinal disorders.  Gastroenterology. 2003;  125 1556-1557
  • 17 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
  • 18 Yang R, Laine L. Mucosal stripping: a complication of push enteroscopy.  Gastrointest Endosc. 1995;  41 156-158
  • 19 Chong J, Tagle M, Barkin J S, Reiner D K. Small bowel push-type fiberoptic enteroscopy for patients with occult gastrointestinal bleeding or suspected small bowel pathology.  Am J Gastroenterol. 1994;  89 2143-2146
  • 20 May A, Nachbar L, Schneider M, Neumann M, Ell C. Push-and-pull enteroscopy using the double-balloon technique: method of assessing depth of insertion and training of the enteroscopy technique using the Erlangen Endo-Trainer.  Endoscopy. 2005;  37 66-70
  • 21 Ramsay M A. Measuring level of sedation in the intensive care unit.  JAMA. 2000;  284 441-442
  • 22 Bell G D. Preparation, premedication, and surveillance.  Endoscopy. 2004;  36 23-31
  • 23 Parry S D, Welfare M R, Cobden I, Barton J R. Push enteroscopy in a UK district general hospital: experience of 51 cases over 2 years.  Eur J Gastroenterol Hepatol. 2002;  14 305-309
  • 24 Bachle T, Ruhl U, Ott G, Walker S. Enteropathy-associated T-cell lymphoma: manifestation as diet-refractory celiac disease and ulcerating jejunitis; in German.  Dtsch Med Wochenschr. 2001;  126 1460-1463
  • 25 Cellier C, Cuillerier E, Patey-Mariaud d e. et al . Push enteroscopy in celiac sprue and refractory sprue.  Gastrointest Endosc. 1999;  50 613-617
  • 26 Gay G J, Delmotte J S. Enteroscopy in small intestinal inflammatory diseases.  Gastrointest Endosc Clin N Am. 1999;  9 115-123
  • 27 Hoffman M A. Cladribine for the treatment of indolent non-Hodgkin’s lymphomas.  Semin Hematol. 1996;  33 (Suppl 1) 40-44
  • 28 Piro L D. Cladribine in the treatment of low-grade non-Hodgkin’s lymphoma.  Semin Hematol. 1996;  33(1 Suppl 1) 34-39
  • 29 Guchelaar H J, Richel D J, Schaafsma M R. Clinical and toxicological aspects of the antineoplastic drug cladribine: a review.  Ann Hematol. 1994;  69 223-230
  • 30 O’Brien S, Kurzrock R, Duvic M. et al . 2-Chlorodeoxyadenosine therapy in patients with T-cell lymphoproliferative disorders.  Blood. 1994;  84 733-738
  • 31 Baltz J K, Montello M J. Cladribine for the treatment of hematologic malignancies.  Clin Pharm. 1993;  12 805-813
  • 32 Goerres M S, Meijer J W, Wahab P J. et al . Azathioprine and prednisone combination therapy in refractory coeliac disease.  Aliment Pharmacol Ther. 2003;  18 487-494

C. J. J. Mulder

Department of Gastroenterology, VU University Medical Centre

P.O. Box 7057 · 1007 MB Amsterdam · The Netherlands

Fax: +31-20-444-0613

Email: cjmulder@vumc.nl