Therapeutic Double-Balloon Enteroscopy: A Binational, Three-Center Experience

Abstract

Background/Aims: There are few reports focusing on therapeutic small bowel endoscopy. The aim of this study was to analyze the results of therapeutic small bowel endoscopy in a large cohort of patients. Methods: A retrospective study of a prospectively collected database comprising all patients undergoing diagnostic and therapeutic small bowel endoscopy in three centers. Results: A total of 614 double-balloon enteroscopies were performed in 534 patients. The most common pathological findings were angiodysplasias and vascular lesions (n = 98, 18%), mucosal ulcers and erosions (n = 95, 17.8%), polyps and tumors (including patients with familiar polyposis syndrome such as Peutz-Jeghers syndrome, familiar adenomatous polyps syndrome, neurofibromatosis, adenocarcinoma, neuroendocrine tumors and gastrointestinal stromal tumors) (n = 52, 9.7%), and strictures (Crohn’s disease, ischemia, tumors) (n = 12, 2.2%). The mean duration of therapeutic small bowel enteroscopy was 67 min (range 30–115) compared to 50 min (range 25–105) for diagnostic procedures (p < 0.05). A therapeutic small bowel endoscopy was performed in 121 patients (22%). Therapeutic procedures included argon plasma coagulation of vascular lesions (n = 73), polypectomy (n = 49), mucosectomy (n = 5), stricture dilation (n = 7), foreign body extraction (n = 7), injection of fibrin glue (n = 10), and clip placement (n = 5). There were a total of 5 complications (0.9%; paralytic ileus, n = 2, pancreatitis, n = 1, bleeding n = 2). No perforations or deaths occurred. Conclusion: Endoscopists performing double-balloon enteroscopy should be trained and prepared to provide therapeutic interventions for small bowel disorders including argon plasma coagulation, injection, hemoclipping, polypectomy, mucosectomy and foreign body extraction. Therapeutic small bowel endoscopy, albeit associated with complications in about 1% of cases, can be considered a relatively safe procedure.

New method of direct percutaneous endoscopic jejunostomy tube placement using balloon‐assisted enteroscopy with fluoroscopy

“…In addition to describing a new technique our data add to the growing literature on BAE‐DPEJ . Nevertheless, we want to address potential limitations of our study.…”

“…In addition to describing a new technique our data add to the growing literature on BAE-DPEJ. [5][6][7][8][9] Nevertheless, we want to address potential limitations of our study. First, the study was retrospective and thus prone to the bias associated with such a design.…”

“…Even in expert hands, the success rate is only 68% . Recent case reports and series have documented the feasibility of DPEJ using either single‐ or double‐balloon enteroscopy methods . In all these case series, DPEJ was placed using the pull‐through or Ponsky method using a pure endoscopic approach .…”

“…3 Recent case reports and series have documented the feasibility of DPEJ using either single-or double-balloon enteroscopy methods. [5][6][7][8][9] In all these case series, DPEJ was placed using the pull-through or Ponsky method using a pure endoscopic approach. 6,9 Whereas the pull-through method may be quite effective to access the stomach it may not be the safest when puncturing a jejunal loop, as the operator mainly relies on transillumination of light, and finger indentation of the target jejunal loop.…”

Double Balloon Enteroscopy Is a Safe and Effective Procedure in Removing Entrapped Foreign Objects in the Small Bowel for Up to 3 Months

“…Recent case reports have widened the boundary of deviceassisted enteroscopy for extraction of entrapped small bowel foreign bodies; however, the optimal setting for endoscopic approach remains yet to be defined, especially in the absence of consensus guidelines. 2 In particular, insufficient data exist for the safety and efficacy of the use of enteroscopy in patients with retained objects. Furthermore, for objects that remain in the small bowel that do not spontaneously pass through the digestive system, the duration that the entrapped object can remain safely in the small bowel is unknown.…”