Effect of Double-Balloon Enteroscopy on Diagnosis and Treatment of Small-Bowel Diseases

Abstract

Background:The diagnosis and treatment of small-bowel diseases is clinically difficult. The purpose of this study was to evaluate the diagnostic and therapeutic value of double-balloon enteroscopy in small-bowel diseases.Methods:The history and outcomes of 2806 patients who underwent double-balloon enteroscopy from July 2004 to April 2017 were reviewed, which included 562 patients with obscure digestive tract bleeding, 457 patients with obscure diarrhea, 930 patients with obscure abdominal pain, 795 patients with obscure weight loss, and 62 patients with obscure intestinal obstruction. Examinations were performed through the mouth and/or anus according to the clinical symptoms and abdominal images. If a lesion was not detected through one direction, examination through the other direction was performed as necessary. Eighty-four patients with small-bowel polyps, 26 with intestinal obstruction caused by enterolith, and 18 with bleeding from Dieulafoy's lesions in the small intestine were treated endoscopically.Results:A total of 2806 patients underwent double-balloon enteroscopy, and no serious complications occurred. An endoscopic approach through both the mouth and anus was used in 212 patients. Lesions were detected in 1696 patients, with a detection rate of 60.4%; the rates for obscure digestive tract bleeding, diarrhea, abdominal pain, weight loss, and intestinal obstruction were 85.9% (483/562), 73.5% (336/457), 48.2% (448/930), 49.1% (390/795), and 62.9% (39/62), respectively. For patients with small-bowel polyps who underwent endoscopic therapy, no complications such as digestive tract bleeding and perforation occurred. Intestinal obstruction with enteroliths was relieved with endoscopic lithotripsy. Among the 18 patients with bleeding from small-bowel Dieulafoy's lesions, 14 patients were controlled with endoscopic hemostasis.Conclusion:Double-balloon enteroscopy is useful for diagnosing and treating some small-bowel disease.

Roles of Capsule Endoscopy and Device-Assisted Enteroscopy in the Diagnosis and Treatment of Small-Bowel Tumors

“…The diagnostic yield of DAE for small-bowel tumors has been reported to be 8.4%-16.8%, and it is generally comparable to that of CE. 2,[31][32][33][34] However, the diagnostic yield of DAE for small-bowel tumors varies according to clinical indication and the higher small-bowel tumor detection rate of DAE has been suggested to result from the difference in the enrolled patients, such as those with suspected small-bowel lesions on previous radiologic studies or CE. 2 In a Japanese study that enrolled 1,035 patients who underwent DAE, small-bowel tumors were detected in 13.9% (144 patients).…”

“…In another Chinese study of 2806 patients who underwent DAE, the detection rate of small-bowel tumors was 8.4% (236 cases). 31 That study enrolled patients without a clear diagnosis in previous examinations including esophagogastroscopy, colonoscopy, abdominal computed tomography, and/or magnetic resonance imaging. In this study, the most common indication for DAE was abdominal pain (930 cases, 33.2%).…”

“…However, it is an uncomfortable procedure for patients, and is labor intensive and time consuming for the operator. While CE is usually considered the initial approach in the diagnostic workup for patients with suspected small-bowel diseases, DAE is useful for differential diagnosis or for confirming the diagnosis of lesions identified using CE or other imaging modalities through visualization or tissue sampling [ 2 , 31 ]. In addition, DAE can be performed in patients with obstructive lesions and offers endoscopic treatment such as balloon dilatation and stent insertion.…”

“…However, the detection rate of small-bowel tumors was 8.5% in patients with OGIB (39/144 cases) and 65.6% in patients with suspected small-bowel tumors (61/93 cases). In another Chinese study of 2806 patients who underwent DAE, the detection rate of small-bowel tumors was 8.4% (236 cases) [ 31 ]. That study enrolled patients without a clear diagnosis in previous examinations including esophagogastroscopy, colonoscopy, abdominal computed tomography, and/or magnetic resonance imaging.…”

Comparison of the Positive Rate and Diagnostic Value of Capsule Endoscopy and Double-Balloon Enteroscopy in Small Bowel Disease: A Retrospective Cohort Analysis

“…5,6 DBE has the characteristics of wide field of vision and clear image, and can be used for biopsy, mucosal staining to mark the lesion site, polyps resection, foreign body removal, etc. [7][8][9] However, the checking time of DBE is long, and patients need to be checked under anesthesia; so, the risks and benefits of DBE need to be weighed comprehensively for patients with older age or many underlying diseases. The purpose of this study was to explore the diagnostic value of CE and DBE for patients who were suspected of having SBD, and to make a comparison between the two checking methods, so as to provide help in the diagnosis and treatment of SBD.…”