Introduction Double balloon enteroscopy (DBE) has become the test of choice for complete investigation of the small bowel.¹Southmead hospital is a large centre in the Southwest of the United Kingdom serving a population of 620,000. It acts as a tertiary referral centre for DBE serving in excess of 2 million people. We report the experience of this centre with 205 patients who underwent DBE under conscious sedation.

Method The endoscopy database was interrogated for all DBE procedures performed from 04/2009 to 10/2014. During this period there were two Consultant operators and an additional Consultant operator started in 05/2013. Data was collected retrospectively on multiple factors associated with the procedure; these included dose of sedative agents, endoscopist and nursing comfort scores and serious complications. The data was analysed by chi-squared, ANOVA, Fisher transformation test and unpaired t-test.

Results 205 procedures were performed over the study period: 139 DBE from above and 66 DBE from below. The mean age (+- standard deviation) was 62.8 (+-2.2) years, range 17–94. All procedures were performed under conscious sedation. The agents used were midazolam alone or with the addition of pethidine or fentanyl. Midazolam was used in 181 cases and the average dose was 5.2mg (+-0.3), range 1–12 mg. The dose was higher for DBE from above (mean 5.6 mg) versus DBE from below (mean 4.36mg) (p < 0.001). Lower doses of midazolam were used in older patients (p < 0.001) and there was no difference between the three endoscopists (p = 0.522). Pethidine was used in 176 cases. The average dose was 44.2 mg (+-1.6) (range 25–50 mg). This did not vary significantly between the two procedure types performed (p = 0.716). Fentanyl was used in 5 cases with a mean dose of 80mcg. Comfort scores recorded by nursing staff and endoscopists were compared using the departmental comfort score which rates discomfort during endoscopic procedures from 0 (comfortable) to 3 (severe discomfort). 50% of the procedures were performed with a rating of zero. Two was the maximum pain score attributed to any procedure and this occurred in only 11% of cases. Comfort scores were well correlated between nursing and endoscopist reporting (p < 0.001). DBE from above was significantly better tolerated than DBE from below (p < 0.001) and older patients tolerated the procedure significantly better than younger patients (p = 0.023). There were no cases of perforation, significant bleeding, 8 day readmission nor 30-day mortality.

Conclusion We have demonstrated in this large cohort of patients that DBE under conscious sedation is safe and well tolerated without the need for general anaesthesia.

Disclosure of interest None Declared.

Reference

1. Rahmi G, Samaha E, Vahedi K et al. Multicenter comparison of double-balloon enteroscopy and spiral enteroscopy. J Gastroenterol Hepatol. 2013;28:992–998