Introduction The advent of small bowel capsule endoscopy (CE) has greatly improved the diagnosis of small bowel tumours. Double balloon enteroscopy (DBE) is the interventional counterpart to CE and has the advantage of direct visualisation of small bowel pathology, biopsy and therapeutic capability. There is however a paucity of data on the use of DBE for small bowel tumours. The aim of this study was to assess the utility of DBE for small bowel tumours and to assess its impact on the diagnostic pathway in this cohort.
Methods Data was collected prospectively on all DBE procedures performed routinely between July 2006 and December 2013 particularly for the indication of small bowel tumours. Patient demographics, clinical presentation, findings at DBE and subsequent follow up data were recorded. The majority of patients had a number of investigations, including radiology, prior to DBE without a firm diagnosis. 83.3% had CE prior to DBE. SPSS V18 was used to analyse the data.
Results A total of 358 DBE procedures were carried out during the stated time period. Of these procedures, 18 (5.0%) were for the indication of suspected small bowel tumour. The majority (57.1%) of these patients were female and the average age at the time of diagnosis was 58 years (SD±12 y). Indications for performing DBE included iron deficiency anaemia 44.4%, overt bleeding 27.8%, abnormal radiology 22.2% and abdominal pain 5.6%. Of those who had prior CE, CE was positive in 93.3% (14/15) of patients with the presence of a mass lesion (50%), stricture or ulceration (35.7%) or the presence of blood alone (14.3%). Anterograde DBE was performed in 88.9% whilst the remaining number had DBE via the retrograde route. Tumour was successfully identified at DBE in 78% (n = 14) of patients, where tattoos were placed and histology obtained. Of the 4 patients where DBE failed to reach the lesion, the diagnosis was confirmed by laparotomy in 3 patients and intra-operative endoscopy in 1 patient. The final histological diagnosis of tumours identified is shown in Figure 1, UK. 61.1% tumours were located in the jejunum, 27.8% in the ileum and 11.1% in the distal duodenum. DBE influenced ongoing management in all patients that achieved a diagnosis from the procedure.
Conclusion DBE plays a valuable role in the investigation pathway of patients with suspected small bowel tumours. The step wise approach of CE followed by DBE allows efficient use of small bowel resources.
Disclosure of Interest None Declared.