Endoscopy 2005; 37(7): 613-616
DOI: 10.1055/s-2005-870126
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Push-and-Pull Enteroscopy in the Small Bowel Using the Double-Balloon Technique: Results of a Prospective European Multicenter Study

C.  Ell1 , A.  May1 , L.  Nachbar1 , C.  Cellier2 , B.  Landi2 , S.  di Caro3 , A.  Gasbarrini3
  • 1Dept. of Internal Medicine II, HSK Wiesbaden (Teaching Hospital of the University of Mainz), Wiesbaden, Germany
  • 2Dept. of Hepatogastroenterology, Georges Pompidou European Hospital, Paris, France
  • 3Dept. of Internal Medicine and Endoscopic Surgery, Gemelli Hospital, Catholic University of Rome, Italy
Further Information

Publication History

Submitted 20 April 2005

Accepted after Revision 4 May 2005

Publication Date:
11 July 2005 (online)

Background and Study Aims: The aim of this study was to evaluate the feasibility, safety, and clinical impact of push-and-pull enteroscopy (PPE) in patients with suspected or documented small-bowel diseases, in a prospective multicenter trial in three European medical centers.
Patients and Methods: A total of 100 patients (mean age 56 ± 16 years; range 13 - 90) were included at the three institutions between July and November 2004. The leading symptoms were: acute recurrent or chronic gastrointestinal bleeding (n = 64), polyposis syndrome (n = 8), chronic abdominal pain (n = 7), chronic diarrhea (n = 7), and others (n = 14).
Results: No major PPE-associated complications such as perforation, bleeding, or relevant injury to the small-bowel tissue or mesentery were encountered. Minor complications occurred in 12 %. The mean time required to carry out the procedure from the oral and anal approaches was 75 ± 19 min (32 - 150min). The average insertion depths into the small bowel were 200 ± 70 cm per PPE session (220 ± 90 cm with the oral approach and 130 ± 80 cm with the anal approach). The average radiation exposure (including diagnostic and therapeutic interventions) was 2.1 ± 2.4 min and 155 ± 159 dGy/cm2. PPE was fully diagnostic in 72 % of cases. The majority of the patients (34 %) were suffering from angiodysplasias; ulcerations and erosions of various etiologies were seen in 16 %, and polyps and tumors in 13 %. The PPE findings played a role in the subsequent treatment in 62 % of the patients. Endoscopic treatments, including argon plasma coagulation, polypectomy, dilation, and foreign-body extraction, were carried out in 42 %. Medical treatment was given in 12 %, and patients were referred for surgery in 8 % of cases.
Conclusions: This prospective analysis shows that PPE is safe and has a high diagnostic and therapeutic yield in patients with suspected or known small-bowel disease.

References

  • 1 Ell C, Remke S, May A. et al . The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding.  Endoscopy. 2002;  34 685-689
  • 2 Delvaux M, Fassler I, Gay G. Clinical usefulness of the endoscopic video capsule as first intestinal investigation in patients with obscure digestive bleeding: validation of a diagnostic strategy based on patient's outcome at 12 months.  Endoscopy. 2004;  36 1067-1073
  • 3 Yamamoto H, Sekine Y, Sato Y. et al . Total enteroscopy with a nonsurgical steerable double-balloon method.  Gastrointest Endosc. 2001;  53 216-220
  • 4 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
  • 5 Yamamoto H, Kita H, Sunada K. et al . Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases.  Clin Gastroenterol Hepatol. 2004;  2 1010-1016
  • 6 May A, Nachbar L, Schneider M. et al . Push-and-pull enteroscopy using the double-balloon technique (double-balloon enteroscopy): feasibility, diagnostic and therapeutic yield in patients with suspected small bowel diseases. [in press].  Gastrointest Endosc. 2005; 
  • 7 May A, Nachbar L, Schneider M. et al . 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
  • 8 Shimizu S, Tada M, Kawai K. Development of a new insertion technique in push-type enteroscopy.  Am J Gastroenterol. 1987;  82 844-847
  • 9 Benz C, Jakobs R, Riemann J F. Do we need the overtube for push enteroscopy?.  Endoscopy. 2001;  33 658-661
  • 10 Taylor A C, Chen R Y, Desmond P V. Use of an overtube for enteroscopy: does it increase depth of insertion? A prospective study of enteroscopy with and without an overtube.  Endoscopy. 2001;  33 227-230
  • 11 Gasbarrini A, di Caro S, May A. et al . The European experience with double-balloon endoscopy: indications, methodology, safety and clinical impact. [in press].  Gastrointest Endosc. 2005; 

C. Ell, M. D., Ph. D.

Dept. of Internal Medicine II · HSK Wiesbaden

Phone: Ludwig-Erhard-Strasse 100 · 65199 Wiesbaden · Germany

Fax: +49-611-43-2418

Email: ell.hsk-wiesbaden@arcor.de