Introduction Double Balloon Enteroscopy (DBE) allows visualisation and interventional therapy throughout the small bowel. It was commenced in South Tyneside District Hospital (STDH) in January 2010 to complement the existing capsule endoscopy service.
Methods Records were examined retrospectively for all DBEs at STDH between 1/1/2010 & 31/12/2015 to determine the indication, route & depth of insertion, findings & therapies performed & the complications.
Results 92 procedures were performed from 172 referrals: (47%) via oral route, (52%) via anal route and (1%) via ileostomy. Procedures were done under conscious sedation or propofol, with GA for planned therapeutic cases. The average depth of insertion for the oral route was 174 cm & 96 cm for the anal route. The overall average insertion time was 71 minutes. (61%) had tattoo applied.
The indications were to evaluate suspected or confirmed Crohn’s disease (38%), obscure mid gastrointestinal (GI) bleeding (28%), suspected malignancy or abnormal imaging (20%), detect polyps in suspected or confirmed polyposis syndrome (7%) and refractory coeliac (1%). 25% of patients had more than one indication for DBE.
DBE findings: 50% had normal examinations, 11% Crohn’s disease, 16% non-specific inflammation, 10% polyps, 4% tumours and 1% coeliac disease. Other diagnoses included small bowel angioectasia and radiation enteritis. The overall diagnostic yield was 50%. The diagnostic yield for suspected Crohn’s disease was 29%, evaluation of obscure mid GI bleeding was 31%, suspected polyps was 40%, refractory Coeliac was 100% and the evaluation of malignancy and abnormal imaging was 11%. 95% of patients who had a normal DBE had prior abnormalities in their imaging.
Limitations: 10 procedures were incomplete due to equipment failure (5), persistent looping (4) & inability to pass strictures (1). 1 was abandoned due to poor bowel preparation.
Therapy was performed in 13 (14%) procedures: 3 dilatation of strictures, 5 had Argon Plasma Coagulation, 4 polypectomies and 1 had a bleeding ulcer clipped. No complications were recorded at DBE for any patients
Conclusion Our DBE service is safe and complements other imaging modality. Our overall diagnostic yield is 50%. Our main indication for DBE is to evaluate suspected Crohn’s (38%) rather than for obscure GI bleeding as in the literature.1 Even with stringent case selection the diagnostic yield for DBE was lower than the preceding VCE.
Reference 1 Seong Ran, et al. Changes over time in indications, diagnostic yield, and clinical effects of double-balloon enteroscopy. Clin Gastroenterol Hepatol 2012;10(10):1152–1156.
Disclosure of Interest None Declared