Double-balloon enteroscopy: The diagnosis and management of small bowel diseases

Özet

Amaç: Çift balon enteroskopi ince barsak görüntülenmesi için geliştirilen yeni bir tekniktir. Bu çalışmanın amacı ince barsak hastalığı olan veya ince barsak patolojisinden şüphelenilen hastalarda çift balon enteroskopinin tanı ve tedavideki önemini değerlendirmektir. Metod: Bu tek merkezli prospektif bir çalışmadır. Toplam 216 çift balon enteroskopi işlemi (168 antegrad, 48 retrograd) ince barsak patolojisi düşünülen 188 hastaya yapıldı. Komplikasyon, işlem süresi, gidilen mesafe, tanı ve tedavi oranları değerlendirilmiştir. Bulgular: Endikasyonlar obscure gastrointestinal sistem kanaması, demir eksikliği anemisi, radyolojik tetkiklerde anormallik, karın ağrısı, ishal ve çölyak hastalığı idi. 130 (%69) hastaya tanı konuldu. En sık rastlanan patolojik bulgu angiodisplazi (29), ülser (%16) ve Crohn's hastalığıdır (%9). Ortalama işlem süresi antegrad olarak 116.4±7.17 dk, ve ortalama pilordan sonra ilerleme mesafesi 310.65±90.3 cm idi. Tedavi edici girişim 66 hastaya yapıldı (56 angiodisplazi, 4 ülser, 4 striktür, ve 2 polip), %97 başarı sağlandı. Ciddi komplikasyon olmadı, ancak işlem sonrası pankreas enzim takibi yapılan 48 hastanın 6'sında (%12.5) pankreatit gelişti. Sonuç: Çift balon enteroskopi ince barsak hastalıkları tanısında uygulanabilir yararlı bir yöntemdir.

Abstract

Background/aims: Double-balloon enteroscopy is a novel endoscopic technique developed to investigate small bowel diseases. The aim of this study was to evaluate the diagnostic and therapeutic impact of double-balloon enteroscopy in patients with suspected or documented small bowel disease who were referred to our tertiary center, which was the first to introduce the double-balloon enteroscopy system in Turkey. Methods: This is a single-center prospective study. A total of 216 double-balloon enteroscopy procedures (168 antegrade, 48 retrograde) were done in 188 patients who were referred to our center for suspected small bowel disease. The main outcome measurements were complications, insertion depth and duration, and diagnostic and therapeutic rates. Results: Indications included obscure gastrointestinal system bleeding, iron deficiency anemia, abnormality on radiographic evaluation, abdominal pain, diarrhea, and suspected celiac disease. A diagnosis was established in 130 (69%) patients. The most common pathologic findings included angiodysplasias (29%), ulcerations (16%) and Crohn's disease (9%). Mean time±standard deviation to perform the examination using the antegrade route was 116.4±7.17 min, and the average±standard deviation insertion length was 310.65±90.3 cm (beyond the pylorus). Therapeutic interventions were performed in 66 patients (56 angiodysplasias, 4 ulcers, 4 strictures, and 2 polyps), and the success rate was 97%. No serious complication was observed, although pancreatitis occurred in 6 of 48 (12.5%) patients who were followed up for post-procedure pancreatic enzyme levels. Conclusions: Our prospective analysis suggests that double-balloon enteroscopy is a feasible and useful technique for the diagnosis as well as treatment of small intestinal disorders.