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

Li Tang, Liu-Ye Huang, Jun Cui, Cheng-Rong Wu, Li Tang, Liu-Ye Huang, Jun Cui, Cheng-Rong Wu

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.

Keywords: Diagnosis; Double-Balloon Enteroscopy; Small Bowel; Therapy.

Conflict of interest statement

There are no conflicts of interest

Figures

Figure 1
Figure 1
High-risk stromal tumor in the small intestine complicated by bleeding.
Figure 2
Figure 2
Small intestinal lymphoma.
Figure 3
Figure 3
Small intestinal angioma.
Figure 4
Figure 4
Intestinal duplication complicated by ulcer and bleeding.
Figure 5
Figure 5
Leiomyosarcoma protruding into the small intestinal lumen.

References

    1. Shin JY, Park IS, Bang BW, Kim HK, Shin YW, Kwon KS, et al. A case of primary small bowel melanoma diagnosed by single-balloon enteroscopy. Clin Endosc. 2017;50:395–9. doi: 10.5946/ce.2016.153.
    1. Saito Y, Hiramatsu K, Nosaka T, Ozaki Y, Takahashi K, Naito T, et al. A case of protein-losing enteropathy caused by sclerosing mesenteritis diagnosed with capsule endoscopy and double-balloon endoscopy. Clin J Gastroenterol. 2017;10:351–6. doi: 10.1007/s12328-017-0755-y.
    1. de Latour RA, Kilaru SM, Gross SA. Management of small bowel polyps: A literature review. Best Pract Res Clin Gastroenterol. 2017;31:401–8. doi: 10.1016/j.bpg.2017.06.003.
    1. Rahmi G, Vinet MA, Perrod G, Saurin JC, Samaha E, Ponchon T, et al. Efficacy of double-balloon enteroscopy for small-bowel polypectomy: Clinical and economic evaluation. Therap Adv Gastroenterol. 2017;10:465–72. doi: 10.1177/1756283X17696232.
    1. Holleran G, Hussey M, McNamara D. Small bowel Dieulafoy lesions: An uncommon cause of obscure bleeding in cirrhosis. World J Gastrointest Endosc. 2016;8:568–71. doi: 10.4253/wjge.v8.i16.568.
    1. Lipka S, Rabbanifard R, Kumar A, Brady P. A single-center United States experience with bleeding Dieulafoy lesions of the small bowel: Diagnosis and treatment with single-balloon enteroscopy. Endosc Int Open. 2015;3:E339–45. doi: 10.1055/s-0034-1391901.
    1. Nakano M, Oka S, Tanaka S, Igawa A, Kunihara S, Ueno Y, et al. Indications for small-bowel capsule endoscopy in patients with chronic abdominal pain. Intern Med. 2017;56:1453–7. doi: 10.2169/internalmedicine.56.7458.
    1. Takenaka K, Ohtsuka K, Kitazume Y, Matsuoka K, Fujii T, Nagahori M, et al. Magnetic resonance evaluation for small bowel strictures in Crohn's disease: Comparison with balloon enteroscopy. J Gastroenterol. 2017;52:879–88. doi: 10.1007/s00535-016-1284-z.
    1. Gurudu SR, Bruining DH, Acosta RD, Eloubeidi MA, Faulx AL, et al. ASGE Standards of Practice Committee. The role of endoscopy in the management of suspected small-bowel bleeding. Gastrointest Endosc. 2017;85:22–31. doi: 10.1016/j.gie.2016.06.013.
    1. Tsujikawa T, Bamba S, Inatomi O, Hasegawa H, Ban H, Nishida A, et al. Factors affecting pancreatic hyperamylasemia in patients undergoing peroral single-balloon enteroscopy. Dig Endosc. 2015;27:674–8. doi: 10.1111/den.12449.
    1. Girelli CM, Pometta R, Facciotto C, Mella R, Bernasconi G. First report of splenic rupture following deep enteroscopy. World J Gastrointest Endosc. 2016;8:391–4. doi: 10.4253/wjge.v8.i9.391.
    1. Nam EJ, Kim GW, Kang JW, Im CH, Jeon SW, Cho CM, et al. Gastrointestinal bleeding in adult patients with Henoch-Schönlein purpura. Endoscopy. 2014;46:981–6. doi: 10.1055/s-0034-1377757.
    1. Górecki W, Bogusz B, Zając A, Sołtysiak P. Laparoscopic and laparoscopy-assisted resection of enteric duplication cysts in children. J Laparoendosc Adv Surg Tech A. 2015;25:838–40. doi: 10.1089/lap.2015.0103.
    1. Nakano A, Nakamura M, Watanabe O, Yamamura T, Funasaka K, Ohno E, et al. Endoscopic characteristics, risk grade, and prognostic prediction in gastrointestinal stromal tumors of the small bowel. Digestion. 2017;95:122–31. doi: 10.1159/000454728.
    1. Gaspar JP, Stelow EB, Wang AY. Approach to the endoscopic resection of duodenal lesions. World J Gastroenterol. 2016;22:600–17. doi: 10.3748/wjg.v22.i2.600.
    1. Ishioka M, Jin M, Matsuhashi T, Arata S, Suzuki Y, Watanabe N, et al. True primary enterolith treated by balloon-assisted enteroscopy. Intern Med. 2015;54:2439–42. doi: 10.2169/internalmedicine.54.5208.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe