Clinical Safety and Utility of Pediatric Balloon‐assisted Enteroscopy

Abstract

Objectives: The benefit of balloon-assisted enteroscopy (BAE) had been recently documented in pediatric patients, but previous reports are based on single institution experiences. We evaluated the feasibility of pediatric BAE in 8 tertiary referral hospitals throughout Japan. Methods: This was a prospective, multi-institutional study. Patients younger than 18 years were enrolled between April 2014 and March 2017 to undergo double-balloon or single-balloon enteroscopy. Data were collected prospectively using a standardized questionnaire. Results: We enrolled 79 pediatric patients (96 procedures, 70 boys, 26 girls; median age 12.7 years, range 1–17 years). Antegrade (oral-route) BAE was performed in 20 procedures (lowest body weight 12.9 kg, youngest age 3.7 years), and retrograde (anal-route) BAE in 76 (lowest body weight 10.8 kg, youngest age 1.6 years). Severe adverse events were associated with BAE in 2 patients: 1 with hemorrhage due to polypectomy and 1 with pancreatitis after double-balloon endoscopic retrograde cholangioscopy. No intestinal perforation was reported. Procedure duration of oral-route BAE for diagnosis was significantly longer than anal-route for diagnosis (P < 0.001). The overall diagnostic yield for rectal bleeding/positive fecal occult blood test and abdominal pain was 48%. Among 40 patients referred for diagnosis who did not undergo capsule endoscopy, diagnoses were confirmed in 17 (42.5%) patients after BAE. Conclusions: This prospective multicenter observational study documents the efficacy of BAE in pediatric patients.

Nationwide survey of pediatric gastrointestinal endoscopy in Japan

“…Hagiwara et al . reported on the use of 96 procedures of pediatric BAE in multicenter study from Japan in 2019; that study included eight institutions and found that BAE could be safely performed even in children aged ≥ 1 year, with an adverse event rate of 2% 32 . The incidence rate of BAE in this study was 3.1%, echoing previous findings.…”

Small bowel endoscopy for children: Collaboration of capsule endoscopy and device‐assisted enteroscopy

“…By contrast, BAE is often performed under general anesthesia, with reports of intravenous anesthesia being used for older children (age >16 years) 27,28 . Although no detailed description of the choice of anesthesia is provided in each of the papers, 2,14,15,27–40 a clear reference cannot be made, but general anesthesia is often chosen for the trans‐oral route, even in older children, whereas intravenous anesthesia is often chosen for the trans‐anal route. The reasons why general anesthesia is often chosen for the trans‐oral route are as follows: the examination time is long, 15 the airway is easily compressed by the overtube in small children, and it is difficult to ensure intraoperative sedation due to the vomiting reflex.…”

“…Indications for balloon‐assisted enteroscopy in children. Data obtained from references 2,14,15,23,40,49–53 . IBD, inflammatory bowel disease; OGIB, obscure gastrointestinal bleeding.…”

“…CO 2 insufflation is recommended to allow deeper small bowel intubation by the scope and to minimize postprocedural discomfort. [12][13][14][15] In addition, the utility of the water exchange method in adults has recently been reported, and there are reports of improved observation of the entire small intestine and insertion depth in SBE. 16 A new DAE, called the power spiral enteroscopy (Table 2) is currently available, 17 but its use in children has not yet been reported, so it is not discussed in this manuscript.…”

“…Figure 3 shows that the younger the age, the more OGIB indications, and as the age increases, abdominal pain, IBD, and polyposis account for a greater percentage. 15,28,29,31,32,35,50,52,54…”