Single-balloon enteroscopy: results from an initial experience at a U.S. tertiary-care center

Abstract

Background: Single-balloon enteroscopy (SBE) is a novel, deep-enteroscopy modality for diagnosis and treatment of disorders of the small bowel.

Objective: The aim of the study was to examine the performance, yield, and safety of SBE in the initial experience at a tertiary-care center.

Design: Retrospective analysis of all SBEs during a 10-month period in 2008. Data were extracted from electronic clinical and endoscopy records.

Setting: U.S. tertiary-care center.

Patients: All patients referred to our center for SBE during the study period were included in the current analysis.

Intervention: SBE.

Main outcome measurements: Anterograde SBE procedure time, diagnostic yield, and complications.

Results: Thirty-eight anterograde SBEs were performed. The mean patient age was 62 years (42% female). Patients were referred for GI bleeding (97%), Crohn's disease, suspected polyps or neoplasia, and abnormal capsule endoscopy results. The mean (+/- SD) procedure time was 49 +/- 19 minutes. The estimated depth of insertion was proximal jejunum (34%), mid-jejunum (45%), and distal jejunum (21%). The SBE diagnostic yield was 47%, with significant findings in 18 patients. Findings included angiectasias, bleeding, abnormal mucosa, ulceration, polyps, and a foreign body. The therapeutic yield was 42%, with lesion ablation performed in 24% of cases. Diagnostic biopsies were performed in 24% of cases and tattooing in 52%. There were no significant complications.

Limitations: Single-center, retrospective study.

Conclusion: Single-balloon enteroscopy appears to be a safe and efficient method for examination of the mid-small bowel. The significant therapeutic yield (42%) suggests that comparative studies with double-balloon and spiral enteroscopy are warranted.

Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Figures

Figure 1

Single balloon enteroscope (9.2 mm diameter, 2.8 mm working-channel, 200 cm working-length) and single balloon overtube (latex-free; deflated balloon seen here at the distal tip).

Figure 2

Representative findings during SBE. (A) Telangiectasia > 75 cm from the ligament of Treitz, treated with argon plasma coagulation. (B) Polyp found > 90 cm from pylorus, treated by lift polypectomy. (C) Post-polypectomy view showing complete removal of polyp. Pathology revealed a hyperplastic polyp; the patient had known Peutz Jeghers Syndrome.

Figure 2

Representative findings during SBE. (A) Telangiectasia > 75 cm from the ligament of Treitz, treated with argon plasma coagulation. (B) Polyp found > 90 cm from pylorus, treated by lift polypectomy. (C) Post-polypectomy view showing complete removal of polyp. Pathology revealed a hyperplastic polyp; the patient had known Peutz Jeghers Syndrome.

Figure 2

Representative findings during SBE. (A) Telangiectasia > 75 cm from the ligament of Treitz, treated with argon plasma coagulation. (B) Polyp found > 90 cm from pylorus, treated by lift polypectomy. (C) Post-polypectomy view showing complete removal of polyp. Pathology revealed a hyperplastic polyp; the patient had known Peutz Jeghers Syndrome.