Original Article
The European experience with double-balloon enteroscopy: indications, methodology, safety, and clinical impact

https://doi.org/10.1016/j.gie.2005.04.029Get rights and content

Background

Double-balloon enteroscopy (DBE) is a new technique that allows high-resolution visualization, biopsies, and therapeutic interventions in all segments of the GI tract. The objective of the study was to evaluate the indications, the safety, and the clinical impact of DBE.

Methods

This is a retrospective analysis conducted at 4 European medical centers. A total of 62 patients with suspected or documented small-bowel diseases were investigated by DBE. A total of 89 procedures were performed (26 and 9 patients from the oral or the anal route, respectively; 27 patients from both). The main outcome measurements were complications, depth and time of insertion, diagnostics, and therapeutics rates.

Results

No complications occurred. Mean time was 70 ± 30 minutes and 90 ± 35 minutes from the oral and the anal route, respectively. Length of insertion was 254 ± 174 cm beyond the pylorus, 180 ± 150 cm beyond the ileocecal valve, whereas the entire small bowel was completely explored in 10 patients. DBE was diagnostic in 80% of the patients: in 29 of 33 of patients with GI bleeding, in one of 5 patients with iron deficiency anemia and positive fecal occult blood testing, in 3 of 5 patients with chronic diarrhea, in two of 3 patients with abdominal pain, in two of 3 patients with GI cancer (follow-up), in all patients with suspected or refractory celiac disease, and in two of 3 patients with Crohn's disease. Treatment was performed in 41.9% of patients (22 polyps and 29 angioectesias).

Conclusions

DBE is a safe and feasible diagnostic and therapeutic tool for suspected or documented small-bowel diseases. At present, the best candidates for the procedure appear to be those with obscure GI bleeding.

Section snippets

Patients and methods

Four European medical centers participated to the study: the Gemelli Hospital of the Catholic University in Rome, Italy; the Teaching Hospital of the University of Mainz in Wiesbaden, Germany; the Georges Pompidou European Hospital in Paris, France; and the Free University Medical Centre in Amsterdam, Holland.

For this retrospective analysis, we selected 62 white patients (43 men, 19 women; mean age 52 ± 35 years) who, between April 2003 and May 2004, underwent DBE because of small-bowel

Results

No complications occurred. DBE was well tolerated by all patients. The only observed side effect was mild abdominal pain on the following day in 3 patients (4.8%).

Mean time to perform the procedure from the oral and anal approaches was 70 ± 30 minutes and 90 ± 35 minutes, respectively. The entire small bowel was completely explored in 10 (16.2%) patients. The endoscope mean length of insertion was as far as 254 ± 174 cm beyond the pylorus and 180 ± 150 cm beyond the ileocecal valve. A

Discussion

The experience of 4 European medical centers demonstrated the crucial diagnostic and therapeutic impact of this new endoscopic system. Our experience suggests that DBE by using the push-and-pull technique might be very effective in reducing hospitalization and avoiding repeated diagnostic workup, or intraoperative enteroscopy and surgical interventions in patients with suspected or previously documented small-bowel disease. Nowadays, DBE, in fact, is the only nonsurgical technique that offers

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