Perspective of Double-Balloon Enteroscopic Diagnoses of Small Intestinal Diseases

Perspective of Double-Balloon Enteroscopic Diagnoses of Small Intestinal Diseases Keigo Mitsui, Shu Tanaka, Atsushi Tatsuguchi, Akihito Ehara, Tsuyoshi Kobayashi, Yoshihasa Sekita, Tsuguhiko Seo, Masaoki Yonezawa, Kazuhiro Nagata, Yoshiaki Shibata, Shunji Fujimori, Teruyuki Kishida, Katya Gudis, Choitsu Sakamoto Background: Recently, novel modalities have been developed for the exploration of small intestinal abnormalities. The development of video capsule endoscopy (VCE) made feasible endoscopic visualization of the entire small bowel. Several prospective studies have confirmed its clinical usefulness and safety. Yet, VCE does have its limitations: it may not be used for either biopsy or treatment. Recent studies have reported a new insertion method of enteroscopyda double-balloon methoddwhich enables endoscopic scrutiny of the entire small bowel with intervention capabilities. However, there have been a few reports concerning its clinical benefits and safety. Aims: To determine the value of double-balloon enteroscopy in the detection of small bowel lesions. Patients & Methods: 65 consecutive patients underwent a total of 90 double-balloon endoscopies between June 2003 and November 2004 at Nippon Medical School Hospital. We used the newly developed EN-450 P5 and T5 double-balloon endoscopes (Fujinon Corp., Saitama, Japan), both with effective working lengths reaching 200 cm and with outer diameters of 8.5 mm and 9.4 mm, respectively. We evaluated patient characteristics, indications, examination times, total enteroscopy rates, diagnostic yields, positive finding rate, and complications. Results: Of the 65 patients, 40 were male and 25 female, with ages ranging from 19 to 82 years (average, 57.2 years). Chief complaints and clinical picture were: overt gastrointestinal bleeding (27 cases), iron deficiency anemia and positive fecal occult blood test (13 cases), differential diagnosis of inflammatory bowel diseases (7 cases), ileus(5 cases), tumor (4 cases), investigation of surgically altered gastrointestinal tract (3 cases), and 6 miscellaneous cases. Average time was 73 (10-150) minutes for the anterograde approach, and 70 (20-180) minutes for the retrograde approach. Endoscopical diagnostic yields were: ulcers (13 cases), tumors (8 cases), stenotic lesions (9 cases), vascular lesions (2 cases), and 8 miscellaneous cases. 37 of 65 cases had positive findings (57%). No major complications were encountered. Conclusions: Double-balloon enteroscopy enables scrutiny of the entire small bowel, tissue sampling, and therapeutic intervention. The procedure is safe and useful, and complements VCE.