Use of a prokinetic agent after double-balloon endoscopy reduces abdominal distension and discomfort, and shortens recovery time: potential adjunct or alternative to CO₂

Over the past few years, greater depth of insertion into the small intestine has allowed gastroenterologists to explore this last uncharted area in the ambulatory setting. A greater amount of experience is being gained with the increased usage of the balloon-assisted enteroscopy. A significant number of patients suffer from abdominal distension after the procedure and in order to reduce this and the associated discomfort, many gastroenterologists have tried using caps on the endoscope or carbon dioxide instead of room air for insufflation [1].

At our center, all double-balloon endoscopies are performed by one physician, and over the past 35 cases all patients have received 10 mg of intravenous metoclopramide at the end of the procedure. It was noticed that all patients went home with minimal or no discomfort and also had a shorter recovery times. Most other factors were kept the same, such as duration of procedure, the sedation used, and route (the majority were anterograde). Although these procedures did not form part of a randomized controlled trial using large patient numbers, this did appear to yield a clinical improvement compared with experience without metoclopramide.

This is only one physician’s experience using a prokinetic agent after the procedure but patient symptoms were improved and the recovery time was shortened by the use of post-procedural metoclopramide. A dedicated study would be needed to validate these results but it is possible that the use of a prokinetic agent may be a noninvasive and cheap method for improving post-procedural symptoms in patients undergoing double-balloon endoscopy.

Competing interests: None

References

• 1 Domagk D, Bretthauer M, Lenz P. et al . Carbon dioxide insufflation improves intubation depth in double-balloon enteroscopy: a randomized, controlled, double-blind trial.  Endoscopy. 2007;  39 1064-1067