No abstract available.
Double-Balloon Enteroscopy*

No abstract available.
Double-Balloon Enteroscopy*

Advances in technology have facilitated the common use of small-bowel imaging. Intraoperative enteroscopy was the gold standard method for small-bowel imaging. However, noninvasive capsule endoscopy and invasive balloon enteroscopy are currently the main endoscopic procedures that are routinely used for small-bowel pathologies, and the indications for both techniques are similar. Although obstruction is a contraindication for capsule endoscopy, it is not considered to be problematic for double-balloon enteroscopy. The most important advantage of double-balloon enteroscopy is the applicability of therapeutic interventions during the procedure; however, double-balloon enteroscopy has certain advantages as well as disadvantages.
Capsule Endoscopy ; Double-Balloon Enteroscopy* ; Pathology

BACKGROUND/AIMS: Until recently, only indirect procedures were available to provide images of the small bowel. Double-balloon enteroscopy (DBE) has the ability to obtain tissue for diagnosis and endoscopic interventions. This study was designed to determine the usefulness of DBE in patients with small bowel diseases by evaluating diagnostic yields and the impact on treatment. METHODS: From November, 2004 to November, 2006 a total 81 patients with suspected small bowel disease were investigated by DBE. We analyzed the diagnostics and therapeutics rates according to the indications of DBE. RESULTS: A total of 114 DBE procedures were performed. Gastrointestinal bleeding (64.2%) was the most common indication, followed by chronic abdominal pain/diarrhea (29.6%). A diagnosis was obtained in 44 of 52 patients with gastrointestinal bleeding and 17 of 24 patients with chronic abdominal pain/diarrhea. DBE resulted in therapeutic intervention in 17 patients with gastrointestinal bleeding and 13 patients with chronic abdominal pain/ diarrhea. DBE was diagnostic in 75.3% of the patients and played a role in the subsequent treatment of 37.0% of the patients. CONCLUSIONS: DBE was a useful and safe method for diagnosis and treatments in patients with small bowel diseases.
Diarrhea ; Double-Balloon Enteroscopy ; Hemorrhage ; Humans

The advent of deep enteroscopy (DE) has dramatically changed diagnostic and therapeutic approaches to small bowel diseases. Unlike capsule endoscopy, which is unable to obtain biopsies or treat a disease, DE techniques have diagnostic and therapeutic capabilities. Double-balloon enteroscopy (DBE) was introduced in 2001, and single-balloon enteroscopy (SBE) and spiral enteroscopy (SE) were subsequently developed for small bowel investigation. In published reports comparing these different enteroscopy techniques, most comparative parameters (depth of insertion, complications, learning curve, diagnostic yield, and therapeutic yield) were comparable among DBE, SBE, and SE. However, the procedure duration appears to be shorter for SE than for DBE and SBE. The rate of complete enteroscopy is clearly superior for DBE, compared with SE and SBE. Because these results do not indicate an increase in diagnostic or therapeutic yield, the clinical impact of complete enteroscopy remains controversial. According to previous studies, the three DE methods seem to be equally effective and safe in the clinical setting. Although larger randomized controlled trials are needed to evaluate the procedural characteristics and clinical impact, the selection of an enteroscopic technique should be based on availability and the endoscopist's experience.
Biopsy ; Capsule Endoscopy ; Double-Balloon Enteroscopy ; Learning Curve

The balloon-assisted enteroscope has been regarded as the standard device for direct visualization of deep small bowels and allows for the diagnosis and treatment of small bowel disease. At the beginning, its application was focused on the diagnosis of obscure gastrointestinal bleeding, inflammatory bowel disease, and small bowel tumor. However, the indications are being expanded to various therapeutic procedures, not only confined to bleeding control. With the expansion of the indications, the need to perform enteroscopy effectively and safely is increasing. Recent studies have been focused on the diagnostic yield, therapeutic yield, and long-term outcomes of the device. However, with the increasing number of procedures, procedural guidelines and quality indicators are also needed.
Diagnosis ; Double-Balloon Enteroscopy ; Endoscopy* ; Hemorrhage ; Inflammatory Bowel Diseases

Obscure gastrointestinal bleeding (OGIB) accounts for 5% of all gastrointestinal (GI) bleeding cases and is often caused by small bowel lesions. Capsule endoscopy (CE), which allows non-invasive visualization of the small bowel mucosa, has revolutionized the evaluation of OGIB. CE is preferred by both patients and physicians mainly because of its non-invasiveness, and is widely used as the first-line diagnostic modality for OGIB. The diagnostic yield of CE in OGIB has been reported to be in the range of 32% to 83%. Although no direct comparison has been made, a meta-analysis showed similar diagnostic yields between CE and double-balloon enteroscopy (DBE) for OGIB. However, CE could enhance the yield of subsequent DBE and serve as a guide for optimizing the insertion route for DBE. Even after negative CE, selected patients could benefit from second-look CE for OGIB. In terms of outcomes, a favorable clinical impact after CE has been reported in several studies. However, observations indicate that CE might not influence clinical outcomes directly, but rather play a role in selecting patients with OGIB who are likely to benefit from subsequent evaluation and intervention.
Capsule Endoscopy* ; Diagnosis ; Double-Balloon Enteroscopy ; Hemorrhage* ; Humans ; Mucous Membrane

Dieulafoy's lesion is a rare cause of severe gastrointestinal bleeding. In most cases, Dieulafoy's lesion is typically found in the stomach within 6 cm from the gastroesophageal junction, but the presence of lesions has also been described throughout the gastrointestinal tract. A jejunal Dieulafoy's lesion is extremely rare, and only a few cases have been reported in the Korean population. We experienced a case of a jejunal dieulafoy's lesion mimicking a submucosal tumor that presented with massive gastrointestinal bleeding. The lesion was diagnosed by the use of double balloon enteroscopy and was then confirmed by a pathological examination of the surgical specimen.
Double-Balloon Enteroscopy ; Esophagogastric Junction ; Gastrointestinal Tract ; Hemorrhage ; Jejunum ; Stomach

BACKGROUND/AIMS: Providers may be hesitant to perform double-balloon enteroscopy (DBE) in the elderly because the increased number of co-morbidities in this population poses a greater risk of complications resulting from sedation. There are limited data on the use of DBE in the elderly. Here, we assessed the safety and efficacy of DBE in the elderly compared to those in younger patients. METHODS: We retrospectively analyzed the medical records of 158 patients who underwent 218 DBEs. Patients were divided into an elderly group (age > or =65 years; mean 71.4+/-5.4; n=34; 41 DBEs) and a younger group (age <65 years; mean 39.5+/-13.5; n=124; 177 DBEs). RESULTS: In both groups, the most common indication for DBE was obscure gastrointestinal bleeding. Mucosal lesions (33.3% vs. 60.9%; P=0.002) were the most common finding in both groups, followed by tumors (30.8% vs. 14.1%; P=0.036). The elderly were more likely to receive interventional therapy (51.3% vs. 23.5%; P=0.001). The diagnostic yield of DBE was slightly higher in the elderly group (92.3% vs. 86.5%; P=0.422), but was not statistically significant. The therapeutic success rate of DBE was 100% in the elderly group compared to 87.5% in the younger group (P=0.536). The overall DBE complication rate was 1.8% overall, and this rate did not differ significantly between the groups (2.6% vs. 1.7%; P=0.548). CONCLUSIONS: DBE is safe and effective in the elderly, and has a high diagnostic yield and high therapeutic success rate.
Aged* ; Double-Balloon Enteroscopy* ; Hemorrhage ; Humans ; Medical Records ; Retrospective Studies

Since the first introduction of double balloon enteroscopy (DBE) in 2001, DBE has been refined for complete exploration of the small bowel and therapeutic interventions. Diagnostic DBE using a model EN-450P5 (Fujinon, Saitama, Japan) equipped with a small accessory channel is mainly used for endoscopic observation and limited therapeutic procedures including injection therapy, argon plasma coagulation and polypectomy. Therapeutic DBE utilizing a model EN-450T5 (Fujinon, Saitama, Japan) equipped with a larger accessory channel was developed for various endoscopic interventions. Recently, new enteroscopic techniques such as single balloon enteroscopy and spiral enteroscopy were introduced. These enteroscopic techniques are all used for the controlled observation, targeted tissue sampling for pathologic evaluation and various therapeutic interventions. The overall complication rate of DBE seems acceptable but that of therapeutic DBE is higher than diagnostic DBE and therapeutic colonoscopies because the small intestinal wall is much thinner than other intestinal wall. This review provides an overview concerning therapeutic interventions of DBE.
Argon Plasma Coagulation ; Colonoscopy ; Double-Balloon Enteroscopy ; Endoscopy ; Intestine, Small