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Predictors of Depth of Maximal Insertion at Double-Balloon Enteroscopy

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Abstract

The aim of this study was to determine the factors predictive of the depth of maximal insertion (DMI) at double-balloon enteroscopy (DBE). Eligible patients from the DBE database at our institution were stratified based on their anterograde or retrograde approach. The factors predictive of the DMI were calculated using ANOVA, Spearman, univariate, and multivariate regression analysis. A total of 79 patients had 98 procedures, 67 anterograde and 31 retrograde. Fifty-eight (73%) had previous abdominal surgeries. The average anterograde DMI was 187.5 cm, retrograde 116.5 cm. In univariate regression analysis, a history of abdominal surgery and surgery excluding appendectomy were negative predictors of the DMI for both the anterograde and retrograde approaches (P < 0.05). A history of bowel surgery and number of surgeries were negative predictive factors only for the anterograde approach (P < 0.005). In multivariate analysis, the number of abdominal surgeries (anterograde) and any abdominal surgery (retrograde) were predictors of the DMI (P = 0.02 and P = 0.003, respectively). Patients with three or more surgeries had a significantly lower DMI than those with ≤1 (137 vs. 214 cm, P < 0.001 for anterograde and 114 vs. 148 cm, P < 0.001 for retrograde). There was no correlation between the DMI and age, BMI, date of the study, or procedure duration for either approach. Previous abdominal surgeries can significantly impact the DMI at DBE.

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References

  1. 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;2:1010–1016. doi:10.1016/S1542-3565(04)00453-7.

    Article  PubMed  Google Scholar 

  2. 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;101:2011–2015. doi:10.1111/j.1572-0241.2006.00664.x.

    Article  PubMed  Google Scholar 

  3. Safatle-Ribeiro AV, Kuga R, Ishida R, et al. Is double-balloon enteroscopy an accurate method to diagnose small-bowel disorders? Surg Endosc. 2007;21:2231–2236. doi:10.1007/s00464-007-9353-2.

    Article  PubMed  Google Scholar 

  4. Kaffes AJ, Siah C, Koo JH. Clinical outcomes after double-balloon enteroscopy in patients with obscure GI bleeding and a positive capsule endoscopy. Gastrointest Endosc. 2007;66:304–309. doi:10.1016/j.gie.2007.02.044.

    Article  PubMed  Google Scholar 

  5. May A, Nachbar L, Pohl J, Ell C. Endoscopic interventions in the small bowel using double-balloon enteroscopy: feasibility and limitations. Am J Gastroenterol. 2007;102:527–535. doi:10.1111/j.1572-0241.2007.01063.x.

    Article  PubMed  Google Scholar 

  6. May A, Nachbar L, Schneider M, Ell C. Prospective comparison of push enteroscopy and push-and-pull enteroscopy in patients with suspected small-bowel bleeding. Am J Gastroenterol. 2006;101:2016–2024. doi:10.1111/j.1572-0241.2006.00745.x.

    Article  PubMed  Google Scholar 

  7. Pasha SF, Leighton JA, Das A, et al. Double-balloon enteroscopy and capsule endoscopy have comparable diagnostic yield in small-bowel disease: a meta-analysis. Clin Gastroenterol Hepatol. 2008;6:671–676. doi:10.1016/j.cgh.2008.01.005.

    Article  PubMed  Google Scholar 

  8. 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;62:62–70. doi:10.1016/S0016-5107(05)01586-5.

    Article  PubMed  Google Scholar 

  9. Ell C, May A, Nachbar L, et al. Push-and-pull enteroscopy in the small bowel using the double-balloon technique: results of a prospective European multicenter study. Endoscopy. 2005;37:613–616. doi:10.1055/s-2005-870126.

    Article  CAS  PubMed  Google Scholar 

  10. Di Caro S, May A, Heine DG, et al. DBE-European Study Group. The European experience with double-balloon enteroscopy: indications, methodology, safety, and clinical impact. Gastrointest Endosc. 2005;62:545–550. doi:10.1016/j.gie.2005.04.029.

    Article  PubMed  Google Scholar 

  11. Heine GD, Hadithi M, Groenen MJ, Kuipers EJ, Jacobs MA, Mulder CJ. Double-balloon enteroscopy: indications, diagnostic yield, and complications in a series of 275 patients with suspected small-bowel disease. Endoscopy. 2006;38:42–48. doi:10.1055/s-2005-921188.

    Article  CAS  PubMed  Google Scholar 

  12. Zhong J, Ma T, Zhang C, et al. A retrospective study of the application on double-balloon enteroscopy in 378 patients with suspected small-bowel diseases. Endoscopy. 2007;39:208–215. doi:10.1055/s-2007-966190.

    Article  CAS  PubMed  Google Scholar 

  13. Tsujikawa T, Saitoh Y, Andoh A, et al. Novel single-balloon enteroscopy for diagnosis and treatment of the small intestine: preliminary experiences. Endoscopy. 2008;40:11–15. doi:10.1055/s-2007-966976.

    Article  CAS  PubMed  Google Scholar 

  14. Gross SA, Stark ME. Initial experience with double-balloon enteroscopy at a U.S. center. Gastrointest Endosc. 2008;67:890–897. doi:10.1016/j.gie.2007.07.047.

    Article  PubMed  Google Scholar 

  15. Mehdizadeh S, Han NJ, Cheng DW, Chen GC, Lo SK. Success rate of retrograde double-balloon enteroscopy. Gastrointest Endosc. 2007;65:633–639. doi:10.1016/j.gie.2006.12.038.

    Article  PubMed  Google Scholar 

  16. Yamamoto H, Sekine Y, Sato Y, et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc. 2001;53:216–220. doi:10.1067/mge.2001.112181.

    Article  CAS  PubMed  Google Scholar 

  17. May A, Nachbar L, Schneider M, Neumann M, Ell C. 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;37:66–70. doi:10.1055/s-2004-826177.

    Article  CAS  PubMed  Google Scholar 

  18. Benz C, Jakobs R, Riemann JF. Do we need the overtube for push-enteroscopy? Endoscopy. 2001;33:658–661. doi:10.1055/s-2001-16208.

    Article  CAS  PubMed  Google Scholar 

  19. Taylor AC, Chen RY, Desmond PV. Use of an overtube for enteroscopy–does it increase depth of insertion? A prospective study of enteroscopy with and without an overtube. Endoscopy. 2001;33:227–230. doi:10.1055/s-2001-12799.

    Article  CAS  PubMed  Google Scholar 

  20. Kamal A. Double-balloon enteroscopy: ready for prime time? Gastrointest Endosc. 2008;67:898–901. doi:10.1016/j.gie.2007.10.033.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank Bridget D. Galetti, RN for assistance with collecting data.

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Authors and Affiliations

  1. Department of Medicine, Indiana University School of Medicine, 550 N. University Boulevard UH 4100, Indianapolis, IN, 46202, USA

    Mouen Khashab, Debra J. Helper & Michael V. Chiorean

  2. Clarian/IU Digestive Diseases Center, Indianapolis, IN, USA

    Mouen Khashab, Debra J. Helper & Michael V. Chiorean

  3. Division of Biostatistics, Indiana University Medical School, Indianapolis, IN, USA

    Cynthia S. Johnson

Authors
  1. Mouen Khashab
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  2. Debra J. Helper
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  3. Cynthia S. Johnson
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  4. Michael V. Chiorean
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Corresponding author

Correspondence to Michael V. Chiorean.

Additional information

Dr. Chiorean has received consulting fees and/or honorarium from Spirus Discovery Inc.

Dr. Helper has received consulting fees and/or honorarium from Spirus Discovery Inc.

Dr. Khashab has no conflicts of interest to disclose.

Cynthia Johnson has no conflicts of interest to disclose.

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Khashab, M., Helper, D.J., Johnson, C.S. et al. Predictors of Depth of Maximal Insertion at Double-Balloon Enteroscopy. Dig Dis Sci 55, 1391–1395 (2010). https://doi.org/10.1007/s10620-009-0849-6

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  • DOI: https://doi.org/10.1007/s10620-009-0849-6

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