Double-Balloon Endoscopy: A Novel Endoscopic Technique for the Treatment of Small Intestinal Diseases

Double-Balloon Endoscopy: A Novel Endoscopic Technique for the Treatment of Small Intestinal Diseases Shu Tanaka, Keigo Mitsui, Atsushi Tatsuguchi, Akihito Ehara, Tsuyoshi Kobayashi, Tsuguhiko Seo, Masaoki Yonezawa, Kazuhiro Nagata, Yoshiaki Shibata, Shunji Fujimori, Teruyuki Kishida, Katya Gudis, Choitsu Sakamoto Background and Aims: Endoscopic observation and treatment of the small bowel has been limited by its inaccessibility. Recently, Yamamoto et al. have reported a new insertion method of enteroscopy, double-balloon endoscopy (Fujinon EN-450P5/20, EN-450T5/20, Fuji Photo Optical Co., Ltd., Tokyo, Japan), which allows endoscopic scrutiny and treatment of the entire small bowel, with intervention capabilities; using two balloons to alternately grip the intestinal wall. This method enables us to investigate the pathophysiology of the small intestine, and allows for timely endoscopic treatment of disorders heretofore requiring surgical intervention. In this study we evaluated the efficacy of the double-balloon enteroscopy system in the endoscopic treatment of the small bowel. Results: 65 patients underwent a total of 90 double-balloon enteroscopies; between June 2003 and October 2004 at Nippon Medical School, Tokyo, Japan. The median age was 60.9 (range, 33-81) years. In all, 9 patients were successfully treated in the process of endoscopic examination. Electrocoagulation for hemostasis at the bleeding source, such as regions of angiodysplasia deep in the small bowel, was conducted in 4 patients. Direct observation of surgically bypassed tract or afferent loop of the Roux-en-Y or Billroth II anastomosis, and scrutiny of the bile duct after gastrointestinal reconstruction, were performed endoscopically in 3 patients. Endoscopic balloon dilatation of a stricture in the small intestine was carried out in 1 patient with delayed stenosis following abdominal blunt trauma, and a foreign body trapped by ileal stenosis was retrieved successfully in another patient. The extent of lesions ranged over the whole small intestine, with inclusion of a blind loop not accessible by capsule endoscopy. All these treatments were outside the scope of conventional methods, but were made possible by this innovative system, which improved access to previously inaccessible areas of the small intestine. We encountered no complications during and after any procedure. Conclusions: Double-balloon enteroscopy is being proven to be a safe and valuable method, with high diagnostic yield offering a wide range of therapeutic capabilities. Our results suggest that double-balloon enteroscopy can dramatically increase the range of endoscopic treatment and may in certain cases preclude unnecessary surgical intervention. Abstracts