Original Article
Double-balloon enteroscopy (push-and-pull enteroscopy) of the small bowel: feasibility and diagnostic and therapeutic yield in patients with suspected small bowel disease

https://doi.org/10.1016/S0016-5107(05)01586-5Get rights and content

Background

Double-balloon enteroscopy (push-and-pull enteroscopy) is a new method that allows complete visualization, biopsy, and treatment in the small bowel. This study evaluated the feasibility and the diagnostic and the therapeutic yield of double-balloon enteroscopy (push-and-pull enteroscopy) in comparison with current imaging methods.

Methods

Between March 2003 and November 2004, 248 consecutive double-balloon enteroscopies (push-and-pull enteroscopies) were performed in a prospective study in 137 patients with suspected small-bowel disease (60 women, 77 men; mean age 56.6 ± 17.8 years), most with chronic GI bleeding (66%). The examinations were carried out after negative evaluations with other methods or to allow biopsy or treatment in patients with known small-bowel findings.

Results

There were no relevant technical problems or severe complications. On average, 240 ± 100 cm of the small bowel was visualized by using the oral route and 140 ± 90 cm was visualized by using the anal route. The investigation time averaged 73.5 ± 25 minutes. The overall diagnostic yield was 80% (109/137 patients). The main diagnosis was angiodysplasia (40/109; 37%); erosions and ulcerations of various etiologies were found in 27% (29/109). Polyps and tumors were identified, including malignancy, in 25% (27/109). Other findings were detected in a further 11%. No relevant pathology was found in 20%. Subsequent treatment was influenced by the results in 104 patients (76%): endoscopic therapy in 57 (41.5%), medical treatment in 23 (17%), and surgery in 24 (17.5%).

Conclusions

Double-balloon enteroscopy (push-and-pull enteroscopy) is safe and easily conducted. Visualization and tissue sampling are possible in the entire small bowel by using the oral and anal approaches, and treatment is possible in the same way as in standard endoscopy, avoiding open surgery. If further prospective studies confirm its value, double-balloon enteroscopy (push-and-pull enteroscopy) may become a standard method of diagnostic and therapeutic endoscopy in the small bowel.

Section snippets

Double-balloon enteroscopy (push-and-pull enteroscopy)

The prototype double-balloon enteroscopy (push-and-pull enteroscopy) system (Fujinon EN-450P5/20; Fujinon Inc, Saitama, Japan) (Fig. 1) consists of a high-resolution videoendoscope, with a working length of 200 cm and an outer diameter of 8.5 mm, and a flexible overtube with a length of 140 cm and an outer diameter of 12 mm. The working channel of the enteroscope has a diameter of 2.2 mm. Latex balloons are attached at the tip of the enteroscope and the overtube, and are inflated and deflated

Results

Details of the approach, the type of enteroscopy (partial or total), the depth of endoscope advancement in centimeters, the preparation time required for the enteroscopy system, and the investigation time and radiation exposure are listed in Table 1. The first two patients with proven angiodysplasias were examined in collaboration with Yamamoto, who published the first description of the double-balloon enteroscopy technique (push-and-pull enteroscopy).11 Because the data for these two patients

Discussion

Attempts to carry out total enteroscopy by using the monorail or the ropeway technique and Sonde enteroscopy were abandoned at the end of the 1980s at the latest, and PE became the standard method for small-bowel enteroscopy.15 The advantages of PE over Sonde enteroscopy, as well as capsule endoscopy, are basically that it is possible to remove tissue and to carry out interventional procedures, e.g., hemostasis. However, only a limited section of the upper small bowel is accessible with PE.

Acknowledgments

We are grateful to Michael Robertson for translating and revising the manuscript.

References (17)

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