Usefulness of Double Balloon Endoscopy in Patients With Surgically Distorted Intestinal Anatomy

Abstract

DBE in patients with distorted intestinal anatomy such as Roux-en-Y anastomosis is a useful tool for the management of small bowel lesions, especially those in the afferent loop.

The role of endoscopy in the management of suspected small-bowel bleeding

“…In patients with surgically altered anatomy in whom portions of the GI tract are bypassed (eg, Roux-en-Y gastrojejunostomy), DAE is the preferred endoscopic modality to assess the excluded luminal segment inaccessible to conventional and capsule endoscopic approaches. 27,28 If these test results are negative, and bleeding recurs, technetium99m pertechnetate scintigraphy (Meckel scan) can be considered in younger patients. Provocative testing with anticoagulants is rarely considered in patients with recurrent small-bowel bleeding, given safety concerns and limited benefit.…”

The role of endoscopy in the management of obscure GI bleeding

“…Furthermore, in patients with surgically altered anatomy in whom portions of the GI tract are bypassed (eg, Roux-en-Y gastrojejunostomy), deep enteroscopy is the preferred endoscopic modality to assess the excluded luminal segment, because other approaches cannot reach these areas. 89,90 For those patients who present with massive bleeding, endoscopy with therapeutic capability (eg, PE or colonoscopy) or referral for angiography are recommended. If these tests are negative, then management as described for inactive overt OGIB is suggested.…”

Double balloon enteroscopy can be safely done in elderly patients with significant co‐morbidities

“…Obscure gastrointestinal bleeding (OGIB) is the most common indication for DBE, which has a 69.8–80.6% diagnostic yield . DBE has also been used in other indications including the evaluation of small bowel obstruction, confirmation of small bowel tumors, and accessing the pancreaticobiliary system in patients with surgically altered anatomy . Its therapeutic applications range from electrocoagulation, clipping, balloon dilation to stenting .…”