Introduction Double balloon enteroscopy (DBE) has revolutionised the diagnosis and therapies available in the management of small bowel diseases. There are currently no large series of its diagnostic and therapeutic capability from Australia.
Methods We evaluated the baseline demographics, diagnostic findings and therapeutic interventions of all patients undergoing DBE between 2004 and 2012 at St. Vincent’s Hospital, Melbourne.
Results There were 357 procedures (218 antegrade) performed in 294 patients (152 female and 142 male). Intubation distances were greater via an antegrade route than retrograde and were even lower in those retrograde cases who had undergone prior abdominal surgery. Thirty-five patients had bidirectional DBE with complete enteroscopy in one of these cases. Indications for DBE included obscure gastrointestinal bleeding (76%), abdominal pain (13%) and diarrhoea (3%). Obscure gastrointestinal bleeding was the main indication contributing to the diagnostic yield of 46% in the entire series. This was especially prevalent in those >75 years, who typically had more cardiorespiratory co-morbidities and were also more likely to be on anti-platelet therapy or anticoagulation. An antegrade approach had a higher diagnostic yield in the series than a retrograde one (54% vs. 34%). Angioectasias were the commonest diagnosis (21% cases) and occurred more frequently in those presenting with overt haemorrhage or requiring transfusion. Polyps/mass lesions (several of which were discovered on screening of patients with polyposis syndromes) and ulcers/strictures (which were typically associated with Crohn’s disease) were the other major diagnostic groups (12 and 4% cases respectively). Both were more prevalent in younger patients. A retrograde approach was better for diagnosis of ulcers/strictures. The therapeutic yield in the entire series of 23% was noticeably better via an antegrade approach and in the elderly. Haemostasis of angioectasias was the commonest therapy (19% cases in the whole series) followed by polypectomy and stricture dilatation (4 and 2% cases in the series respectively), which potentially obviated the need for surgery.
Conclusion DBE is a major contributor to the management of small bowel disease in an Australian population. Obscure gastrointestinal bleeding is the main indication with better diagnostic and therapeutic yields in the elderly and when there is overt haemorrhage or transfusion requirement. An antegrade approach is more useful in these patients unlike in those with ulcers and strictures, who typically had Crohn’s disease and were younger and in whom a retrograde approach was more beneficial. With its diagnostic and therapeutic capability DBE should be contemplated in small bowel disease in the setting of a multidisciplinary approach.
Disclosure of Interest None Declared.