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Achieving Total Enteroscopy by Consecutive Bidirectional Double-balloon Enteroscopy Procedures

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Abstract

Objective

To investigate the feasibility and safety of achieving total enteroscopy by consecutive bidirectional double-balloon enteroscopy (DBE) procedures.

Methods

The demographic data, indication, initial insertion route, examination time for each insertion and the entire procedure, total enteroscopy rate, diagnostic yield and adverse events of patients who attempted to achieve total enteroscopy by consecutive bidirectional DBE procedures from January 2014 to December 2019 were retrospectively analyzed.

Results

A total of 189 patients were included, and the total enteroscopy rate was 87.3%. Initiating the DBE procedure via the retrograde approach as the initial insertion route achieved a higher total enterosocpy rate (90.9% vs. 78.9%, P=0.023), with shorter overall examination time (134.2±36.2 vs. 156.9±47.6 min, P=0.017) and shorter examination time for the opposite insertion route (23.8±19.9 vs. 53.1±27.6 min, P=0.000) compared with anteograde approach as the initial insertion route. The overall diagnostic yield was 37.6%. The diagnostic yield for successfully achieving total enteroscopy was higher, when compared to the yield for not successfully achieving total enteroscopy (39.4% vs. 25%, P=0.029). The overall rate of adverse events was 2.1% (4/189). There was no significant difference in adverse event rate between the overall examination time ≥2 h group and <2 h group (2.1% vs. 2.0%, P=0.593).

Conclusion

Consecutive bidirectional DBE procedure is an effective and safe strategy for achieving total enteroscopy with a considerable success rate. This may be a promising option and alternative to traditional methods, and helpful to more promptly establish a definite diagnosis. The retrograde approach, as the initial insertion route, is preferred in clinical practice.

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References

  1. Jeon SR, Kim JO. Deep enteroscopy: which technique will survive? Clin Endosc, 2013,46(5):480–485

    Article  Google Scholar 

  2. ASGE Technology Committee, Chauhan SS, Manfredi MA, et al. Enteroscopy. Gastrointest Endosc, 2015, 82(6):975–990

    Article  Google Scholar 

  3. May A. Double-Balloon Enteroscopy. Gastrointest Endosc Clin N Am, 2017,27(1):113–122

    Article  Google Scholar 

  4. Xin L, Gao Y, Liao Z, et al. The reasonable calculation of complete enteroscopy rate for balloon-assisted enteroscopy. Endoscopy, 2011,43(9):832

    Article  CAS  Google Scholar 

  5. May A. How much importance do we have to place on complete enteroscopy? Gastrointest Endosc, 2011,73(4): 740–742

    Article  Google Scholar 

  6. May A, Nachbar L, Ell C. Double-balloon enteroscopy (push-and-pull enteroscopy) of the small bowel: feasibility and diagnostic and therapeutic yield in patients with suspected small bowel disease. Gastrointest Endosc, 2005,62(1):62–70

    Article  Google Scholar 

  7. Gao Y, Xin L, Zhang YT, et al. Technical and Clinical Aspects of Diagnostic Single-Balloon Enteroscopy in the First Decade of Use: A Systematic Review and Meta-Analysis. Gut Liver, 2020,15(2):262–272

    Article  Google Scholar 

  8. Xin L, Liao Z, Jiang YP, et al. Indications, detectability, positive findings, total enteroscopy, and complications of diagnostic double-balloon endoscopy: a systematic review of data over the first decade of use. Gastrointest Endosc, 2011,74(3):563–570

    Article  Google Scholar 

  9. Marmo R, Rotondano G, Casetti T, et al. Degree of concordance between double-balloon enteroscopy and capsule endoscopy in obscure gastrointestinal bleeding: a multicenter study. Endoscopy, 2009,41(7):587–592

    Article  CAS  Google Scholar 

  10. Fujita M, Manabe N, Honda K, et al. Long-term outcome after double-balloon endoscopy in patients with obscure gastrointestinal bleeding. Digestion, 2010,82(3):173–178

    Article  Google Scholar 

  11. May A, Färber M, Aschmoneit I, et al. Prospective multicenter trial comparing push-and-pull enteroscopy with the single- and double-balloon techniques in patients with small-bowel disorders. Am J Gastroenterol, 2010,105(3):575–581

    Article  Google Scholar 

  12. Takano N, Yamada A, Watabe H, et al. Single-balloon versus double-balloon endoscopy for achieving total enteroscopy: a randomized, controlled trial. Gastrointest Endosc, 2011,73(4):734–739

    Article  Google Scholar 

  13. Lenz P, Domagk D. Double- vs. single-balloon vs. spiral enteroscopy. Best Pract Res Clin Gastroenterol, 2012,26(3):303–313

    Article  Google Scholar 

  14. Yamamoto H, Sekine Y, Sato Y, et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc, 2001,53(2):216–220

    Article  CAS  Google Scholar 

  15. Yin A, Hu W, Zhao L, et al. Diagnosis and therapy using double-balloon endoscopy for small bowel disease: experience from a Chinese tertiary hospital. J Int Med Res, 2020,48(10):300060520959489.

    Article  CAS  Google Scholar 

  16. Zhao L, Yin A, Liao F, et al. Inspecting the total gastrointestinal tract by consecutive bidirectional double-balloon enteroscopy in patients with suspected small bowel bleeding. Turk J Gastroenterol, 2020,31(10): 688–694

    Article  Google Scholar 

  17. May A, Nachbar L, Schneider M, et al. Push-and-pull enteroscopy using the double-balloon technique: method of assessing depth of insertion and training of the enteroscopy technique using the Erlangen Endo-Trainer. Endoscopy, 2005,37(1):66–70

    Article  CAS  Google Scholar 

  18. Di Caro S, May A, Heine DG, et al. The European experience with double-balloon enteroscopy: indications, methodology, safety, and clinical impact. Gastrointest Endosc, 2005,62(4):545–550

    Article  Google Scholar 

  19. Liu Y, Jiang W, Chen G, et al. Diagnostic Value and Safety of Emergency Single-Balloon Enteroscopy for Obscure Gastrointestinal Bleeding. Gastroenterol Res Pract, 2019,2019:9026278

    PubMed  PubMed Central  Google Scholar 

  20. Yin A, Zhao L, Ding Y, et al. Emergent Double Balloon Enteroscopy in Overt Suspected Small Bowel Bleeding: Diagnosis and Therapy. Med Sci Monit, 2020,26:e920555

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Mönkemüller K, Weigt J, Treiber G, et al. Diagnostic and therapeutic impact of double-balloon enteroscopy. Endoscopy, 2006,38(1):67–72

    Article  Google Scholar 

  22. Lo SK, Mehdizadeh S. Therapeutic uses of double-balloon enteroscopy. Gastrointest Endosc Clin N Am, 2006,16(2):363–376

    Article  Google Scholar 

  23. Sun B, Rajan E, Cheng S, et al. Diagnostic yield and therapeutic impact of double-balloon enteroscopy in a large cohort of patients with obscure gastrointestinal bleeding. Am J Gastroenterol, 2006,101(9):2011–2015

    Article  Google Scholar 

  24. Schneider M, Höllerich J, Beyna T. Device-assisted enteroscopy: A review of available techniques and upcoming new technologies. World J Gastroenterol, 2019,25(27):3538–3545

    Article  Google Scholar 

  25. Domagk D, Mensink P, Aktas H, et al. Single-vs. double-balloon enteroscopy in small-bowel diagnostics: a randomized multicenter trial. Endoscopy, 2011,43(6):472–476

    Article  CAS  Google Scholar 

  26. Messer I, May A, Manner H, et al. Prospective, randomized, single-center trial comparing double-balloon enteroscopy and spiral enteroscopy in patients with suspected small-bowel disorders. Gastrointest Endosc, 2013,77(2):241–249

    Article  Google Scholar 

  27. Yamamoto H, Kita H, Sunada K, et al. Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol, 2004,2(11):1010–1016

    Article  Google Scholar 

  28. Hadithi M, Heine GD, Jacobs MA, et al. A prospective study comparing video capsule endoscopy with double-balloon enteroscopy in patients with obscure gastrointestinal bleeding. Am J Gastroenterol, 2006, 101(1):52–57

    Article  Google Scholar 

  29. Heine GD, Hadithi M, Groenen MJ, et al. Double-balloon enteroscopy: indications, diagnostic yield, and complications in a series of 275 patients with suspected small-bowel disease. Endoscopy, 2006,38(1):42–48

    Article  CAS  Google Scholar 

  30. Mehdizadeh S, Ross A, Gerson L, et al. What is the learning curve associated with double-balloon enteroscopy? Technical details and early experience in 6 U.S. tertiary care centers. Gastrointest Endosc, 2006,64(5):740–750

    Article  Google Scholar 

  31. Kameda N, Higuchi K, Shiba M, et al. A prospective, single-blind trial comparing wireless capsule endoscopy and double-balloon enteroscopy in patients with obscure gastrointestinal bleeding. J Gastroenterol, 2008,43(6): 434–440

    Article  Google Scholar 

  32. Möschler O, May A, Müller MK, et al. Complications in and performance of double-balloon enteroscopy (DBE): results from a large prospective DBE database in Germany. Endoscopy, 2011,43(6):484–489

    Article  Google Scholar 

  33. Li X, Zhao YJ, Dai J, et al. Carbon dioxide insufflation improves the intubation depth and total enteroscopy rate in single-balloon enteroscopy: a randomised, controlled, double-blind trial. Gut, 2014,63(10):1560–1565

    Article  Google Scholar 

  34. Tanaka S, Mitsui K, Tatsuguchi A, et al. Current status of double balloon endoscopy—indications, insertion route, sedation, complications, technical matters. Gastrointest Endosc, 2007,66(3 Suppl):S30–S33

    Article  Google Scholar 

  35. Rondonotti E, Sunada K, Yano T, et al. Double-balloon endoscopy in clinical practice: where are we now? Dig Endosc, 2012,24(4):209–219

    Article  Google Scholar 

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Author notes

  1. The authors contributed equally to this study.

Authors and Affiliations

  1. Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, 430060, China

    Liang Zhao, An-ning Yin, Fei Liao, Yi-juan Ding & Hong-gang Yu

Authors
  1. Liang Zhao
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  2. An-ning Yin
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  3. Fei Liao
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  4. Yi-juan Ding
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  5. Hong-gang Yu
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Corresponding author

Correspondence to Liang Zhao.

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Zhao, L., Yin, An., Liao, F. et al. Achieving Total Enteroscopy by Consecutive Bidirectional Double-balloon Enteroscopy Procedures. CURR MED SCI 42, 144–149 (2022). https://doi.org/10.1007/s11596-022-2523-6

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  • DOI: https://doi.org/10.1007/s11596-022-2523-6

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