Prospective Multicenter Trial Comparing Push-and-Pull Enteroscopy With the Single- and Double-Balloon Techniques in Patients With Small-Bowel Disorders

May, Andrea; Farber, Michael A.; Aschmoneit, Insa; Pohl, Jürgen; Manner, Hendrik; Lotterer, E.; Möschler, O; Kunz, Johannes; Goßner, Liebwin; Mönkemüller, Klaus; Ell, Christian

doi:10.1038/ajg.2009.712

Cited by 211 publications

(189 citation statements)

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“…In total 44 patients underwent antegrade DBE, 11 retrograde DBE and 34 underwent both. Sixteen of the 34 had complete enteroscopy [5,6] . In patients with obscure gastrointestinal bleeding (OGIB) and negative VCE exams, DBE was guided by the patient's history.…”

Section: Patientsmentioning

confidence: 99%

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Accuracy of community based video capsule endoscopy in patients undergoing follow up double balloon enteroscopy

Tenembaum

Sison²,

Rubin³

2013

WJGE

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AIM:To determine the test characteristics of community based video capsule endoscopy (VCE) in patients undergoing sequential VCE and double balloon enteroscopy (DBE). METHODS:Eighty-nine patients (34 females, 55 males, mean age 66) who underwent both VCE and DBE from 2008-2010 were retrospectively reviewed. Lesions detected at VCE were categorized. Capsule directed DBE followed and included 44 antegrade, 11 retrograde and 34 combined antegrade and retrograde procedures. Lesions detected were compared utilizing the McNemar's test. RESULTS:Angioectasia detection with VCE was 25% and with DBE 35% (P < 0.03) with a calculated sensitivity and specificity of 58% and 93% respectively. Polyps were detected by VCE in 22% and in DBE 20%, (P = 0.6), with a sensitivity and specificity for VCE of 61% and 87%. Small bowel diverticula were only seen in 1% of VCE but in 12% of DBE patients (P < 0.002) with a calculated sensitivity and specificity of VCE of 9% and 100%.CONCLUSION: VCE would be moderately sensitive and specific overall with considerable variation by lesion. Furthermore, VCE cannot be relied upon to diagnose small bowel diverticula.© 2013 Baishideng. All rights reserved.Key words: Video capsule endoscopy; Double balloon enteroscopy; Angioectasia; Diverticulosis; Obscure gastrointestinal bleeding Core tip: Advances in endoscopic technology have revolutionized the evaluation of small intestinal disorders. Non-invasive imaging utilizing video capsule endoscopy (VCE) offers the potential to safely visualize the entire small bowel with a high diagnostic yield. It is limited by a lack of therapeutic ability, imprecise localization, failure to reach the colon in all cases and inconsistent visualization of the entire small bowel. Deep enteroscopy, utilizing double balloon enteroscopy (DBE), enables diagnostic and therapeutic endoscopy of the small bowel. Although total enteroscopy can be accomplished, it typically requires antegrade and retrograde approaches. In most clinical situations, VCE is performed initially. By using DBE as the criterion (gold) standard, the sensitivity and specificity of community based VCE can be assessed for individual lesions, offering a more informative comparison than diagnostic yield.

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Section: Patientsmentioning

confidence: 99%

“…Although total enteroscopy can be accomplished, it typically requires antegrade and retrograde approaches. The rate of total enteroscopy varies between 11%-66% [5,6] . In most clinical situations, VCE is performed initially [3] .…”

Section: Introductionmentioning

confidence: 99%

Accuracy of community based video capsule endoscopy in patients undergoing follow up double balloon enteroscopy

Tenembaum

Sison²,

Rubin³

2013

WJGE

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“…Although less data have been published regarding SBE outcomes compared with DBE, initial studies reported somewhat lower diagnostic yields, potentially due to decreased rates of total enteroscopy [4,5]. Higher total enteroscopy rates and therapeutic interventions with DBE compared to SBE were reported when the enteroscope balloon was removed from the Fujinon system [6]. Nevertheless, a subsequent randomized controlled trial did not confirm these results [7].…”

mentioning

confidence: 58%

Long-Term Outcomes After Single-Balloon Enteroscopy: Are They Any Different from Double-Balloon Enteroscopy for Vascular Lesions?

Gerson

2013

Dig Dis Sci

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Obscure GI bleeding is uncommon, accounting for approximately 5 % of all GI bleeding episodes [1]. With the advent of capsule endoscopy and introduction of balloon enteroscopy to the United States in 2004, endoscopic visualization of the small bowel has become feasible and successful. Double-balloon enteroscopy (DBE) is associated with diagnostic yields of approximately 50-60 %, which exceed 70 % in patients with obscure gastrointestinal bleeding (OGIB) [2]. Performance of video capsule endoscopy (VCE) prior to deep enteroscopy is associated with increased diagnostic yields. In an updated metaanalysis, the yield for DBE was 75 % when a prior VCE study was abnormal, but only 27 % after a negative VCE examination [3].Single-balloon enteroscopy (SBE) was subsequently introduced into US clinical practice in 2008 in an effort to reduce time and complexity of the double-balloon procedure. Instead of using a second balloon on the distal end of the enteroscope as an anchor when the overtube is advanced, the tip of the enteroscope is deflected during the SBE procedure, creating a ''hook'' which functions similarly to the second balloon on the DBE enteroscope. Although less data have been published regarding SBE outcomes compared with DBE, initial studies reported somewhat lower diagnostic yields, potentially due to decreased rates of total enteroscopy [4,5]. Higher total enteroscopy rates and therapeutic interventions with DBE compared to SBE were reported when the enteroscope balloon was removed from the Fujinon system [6]. Nevertheless, a subsequent randomized controlled trial did not confirm these results [7].In this issue of Digestive Diseases and Sciences, Kushnir et al. [8] from Washington University School of Medicine performed a retrospective cohort study in order to determine long-term outcomes after SBE. While longterm outcomes studies have been performed for DBE and are discussed below [9,10], this literature contribution is the first long-term outcomes assessment for SBE. Given the conflicting data regarding efficacy of SBE compared to DBE, the major question is whether recurrent bleeding rates differ post-SBE compared to published rates post-DBE. In this study, the authors reviewed 147 SBE examinations performed for the evaluation of OGIB between 2008 and 2010, following 110 (75 %) patients for a mean of 24 months post-procedure. Patients who participated in the follow-up phone calls or visits were more likely to have undergone SBE with positive findings in the small bowel leading to endoscopic therapy compared with patients who were lost to follow-up post-enteroscopy (69 vs. 35 %, p \ 0.001). Seventy percent of the patients had undergone VCE studies before the enteroscopy examination. Significant lesions in the small bowel including vascular, ulcerative, and/or suspected neoplasms were detected in 91 % of the patients undergoing capsule endoscopy. A source of bleeding was identified in 95/147 (65 %) SBE examinations including vascular lesions in 54 %, ulcers or erosions in 5 %, and small bowel masses in 3 %...

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“…Rate of complete small bowel investigations seems to be more regularly achievable using doubleballoon rather than the single-balloon technique whereas the therapeutic impact was similar with SBE and DBE [6][7][8]. Complications are reported in less than 5% of procedures and include pancreatitis (< 1%), bleeding, and perforation, with the rate of complications increasing in therapeutic interventions [9].…”

Section: Endoscopic Imaging In Small Bowel Crohn's Diseasementioning

confidence: 99%

Detecting and Managing Small Bowel Crohn’s Disease – Capsule Endoscopy Becoming a First Line Diagnostic Method?

Hausmann¹,

Albert²

2011

J Gastrointest Dig Syst

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Small bowel endoscopy is crucial for diagnosing small bowel Crohn's disease, and capsule endoscopy is complemented by balloon-assisted enteroscopy to take biopsies and by magnetic resonance imaging to visualize enteral and extra-intestinal involvement. Recently, imaging has also become a key instrument to manage Crohn's disease patients. Treatment control is advised for patients who have undergone bowel resections and is increasingly used to testify treatment success in non-operated patients, too. In this review we present the modern imaging methods to diagnose and to manage Crohn's disease with a special focus on the small bowel. Moreover, current knowledge on the impact of diagnostic methods on the patients' outcome is reported.

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Prospective Multicenter Trial Comparing Push-and-Pull Enteroscopy With the Single- and Double-Balloon Techniques in Patients With Small-Bowel Disorders

Abstract: The complete enteroscopy rate was three times higher with DBE than with SBE, accompanied by a higher diagnostic yield. DBE must therefore continue to be regarded as the nonsurgical gold standard procedure for deep small-bowel endoscopy.

Cited by 211 publications

References 29 publications

Accuracy of community based video capsule endoscopy in patients undergoing follow up double balloon enteroscopy

Accuracy of community based video capsule endoscopy in patients undergoing follow up double balloon enteroscopy

Long-Term Outcomes After Single-Balloon Enteroscopy: Are They Any Different from Double-Balloon Enteroscopy for Vascular Lesions?

Detecting and Managing Small Bowel Crohn’s Disease – Capsule Endoscopy Becoming a First Line Diagnostic Method?

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