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Single incision laparoscopic assisted double balloon enteroscopy: a novel technique to manage small bowel pathology

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Abstract

Background and Aims

Double balloon enteroscopy (DBE) has revolutionised the diagnosis and treatment of small bowel (SB) conditions. However, deep SB insertion can be challenging in patients with a history of abdominal surgery and a two-step procedure is required when findings are not amenable to endoscopic therapy. This case series reports the development of laparoscopically assisted DBE (LA-DBE) using single incision laparoscopic surgery (SILS).

Methods

Retrospective review of LA-DBE procedures performed in a single tertiary centre over 6 years.

Results

Seventeen patients (median age: 40 years, male 41%) underwent 17 LA-DBE procedures. The approach was oral in 13 and rectal in 4. Laparoscopic approach was standard (multi-port) in the first four cases, SILS was then used in all subsequent patients (13/17). Indications for LA-DBE were previously failed standard DBE (n = 16) and need for a combined procedure (n = 1). Indications for DBE were Peutz–Jeghers syndrome (PJS) (n = 10), suspected submucosal/polypoid lesion at small bowel imaging (n = 5) and obscure gastrointestinal bleeding (OGIB) with vascular abnormalities seen at capsule endoscopy (n = 2). In 1/17 the suggested pathology on imaging was not identified. Therapy was applied in 15/17 (88%) cases. Diagnoses were PJS polyps (n = 8), neuroendocrine tumour (NET) (n = 2), PJS and NET (n = 1), transmural arteriovenous malformation (n = 1), angioectesia (n = 1), inflammatory polyp (n = 1), leiomyoma (n = 1) and Meckel’s diverticulum (n = 1). The median (range) procedure time was 147 (84–210) mins. Median (range) length of stay post-procedure was 2 (1–19) days. Three patients developed complications. The 30-day mortality rate was 0%.

Conclusions

LA-DBE is a safe, effective and minimally invasive procedure that can be applied for the management of selected patients with small bowel pathology. A SILS approach allows all therapeutic modalities to be available, including conversion to intraoperative enteroscopy (IOE), laparoscopic small bowel resection and laparotomy.

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Authors and Affiliations

  1. The Wolfson Unit for Endoscopy, St Mark’s Hospital, Watford Road, Harrow, London, HA1 3UJ, UK

    Ioannis Stasinos, Nikolaos Kamperidis, Alberto Murino, Chris Fraser & Adam Humphries

  2. Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, Hampstead, London, UK

    Alberto Murino

  3. Department of Colorectal Surgery, St Mark’s Hospital/Academic Institute, London, UK

    J. T. Jenkins & Janindra Warusavitarne

Authors
  1. Ioannis Stasinos
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  2. Nikolaos Kamperidis
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  3. Alberto Murino
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  4. J. T. Jenkins
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  5. Janindra Warusavitarne
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  6. Chris Fraser
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  7. Adam Humphries
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Corresponding author

Correspondence to Ioannis Stasinos.

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Disclosures

Dr Nikolaos Kamperidis is on the speakers’ bureau of Janssen. Dr Alberto Murino is on the speakers’ bureau of Boston Scientific & GI supply. Dr Adam Humphries receives educational and travel grants from Aquilant and Olympus. Drs Ioannis Stasinos, JT Jenkins, Janindra Warusavitarne and Chris Fraser have no conflicts of interest disclosures or financial ties to disclose.

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Stasinos, I., Kamperidis, N., Murino, A. et al. Single incision laparoscopic assisted double balloon enteroscopy: a novel technique to manage small bowel pathology. Surg Endosc 34, 2773–2779 (2020). https://doi.org/10.1007/s00464-020-07446-2

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  • DOI: https://doi.org/10.1007/s00464-020-07446-2

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