51
|
Sidhu R, Sanders DS. Double-balloon enteroscopy in the elderly with obscure gastrointestinal bleeding: safety and feasibility. Eur J Gastroenterol Hepatol 2013; 25:1230-4. [PMID: 23751353 DOI: 10.1097/meg.0b013e3283630f1b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Double-balloon enteroscopy (DBE) is a novel endoscopic procedure to access the small bowel. There is paucity of data on its use in the elderly. OBJECTIVE The aim of this study was to assess the utility of DBE in patients with obscure gastrointestinal bleeding (OGB) in terms of safety and feasibility. MATERIALS AND METHODS A prospective review of consecutive patients who underwent DBE for OGB was conducted. Data were collected on demographics, dose of sedation/analgesia, diagnostic yield, and management and complications. Patients were divided into group 1, age of at least 70 years, and group 2, age less than 70 years. RESULTS A total of 148 DBE procedures were carried out for OGB. Group 1 (age≥70 years) comprised 27% (n=40) of the cohort with a mean age of 77 years (range 70-83 years). The mean age in group 2 (n=108) was 54 years, 44% women. The diagnostic yield in group 1 was 53 versus 35% in group 2 (P=0.06). Subsequent management was altered more frequently in group 1 (50 vs. 28%, P=0.01, odds ratio 2.6, 95% confidence interval 1.2-5.5). Sedation requirement was less in the elderly (median dose of midazolam, group 1: 4.5 mg versus group 2: 6 mg, P<0.001; fentanyl, group 1: 50 mcg vs. group 2: 75 mcg, P<0.001). There was no significant difference in complications between the two groups (0/40 vs. 1/108, P=0.54). On logistic regression, increasing age (P=0.008) was associated with a higher yield with DBE in all patients. CONCLUSION DBE is safe, has a high diagnostic yield and has a positive impact on patient management in the elderly.
Collapse
Affiliation(s)
- Reena Sidhu
- Department of Gastroenterology, Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK.
| | | |
Collapse
|
52
|
Pongprasobchai S, Chitsaeng S, Tanwandee T, Manatsathit S, Kachintorn U. Yield, etiologies and outcomes of capsule endoscopy in Thai patients with obscure gastrointestinal bleeding. World J Gastrointest Endosc 2013; 5:122-7. [PMID: 23515435 PMCID: PMC3600548 DOI: 10.4253/wjge.v5.i3.122] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 08/22/2012] [Accepted: 01/23/2013] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate the yield, etiologies and impact of capsule endoscopy (CE) in Thai patients with obscure gastrointestinal bleeding (OGIB).
METHODS: The present study is a retrospective cohort study. All patients with OGIB who underwent CE in Siriraj Hospital, Bangkok, Thailand during 2005-2009 were included in the study. All the patients’ medical records and results of the CE videos were reviewed. CE findings were classified as significant, suspicious/equivocal and negative. Sites of the lesions were located to duodenum, jejunum, jejunoileum, ileum and diffuse lesions by the localization device of the CE. Impact of CE on the patients’ management was defined by any investigation or treatment given to the patients that was more than an iron supplement or blood transfusion. Patients’ outcomes (rebleeding, persistent bleeding, anemia or requirement of blood transfusion) were collected from chart reviews and direct phone interviews with the patients.
RESULTS: Overall, there were 103 patients with OGIB included in the study. Mean age of the patients was 64 ± 16 years (range 9-88 years) and 57 patients (55%) were male. Types of OGIB were overt in 80 (78%) and occult in 23 patients (22%). The median time interval of CE after onset of OGIB was 10 d (range 1-180 d). The median time of follow-up was 19 mo (range 1-54 mo). Capsules reached caecum in 77 patients (74%) and capsule retention was found in 1 patient (1%). The diagnostic yield of CE revealed significant lesions in 37 patients (36%), suspicious/equivocal lesions in 15 patients (15%) and 51 patients (49%) had negative CE result. Among the significant lesions, the bleeding etiologies were small bowel ulcers in 44%, angiodysplasia in 27%, small bowel tumor in 13%, miscellaneous in 8% and active bleeding without identifiable causes in 8%. Patients with small bowel ulcers were significantly associated with the use of non-steroidal anti-inflammatory drugs (48%, P = 0.034), while patients with small bowel tumors were more commonly female (86%, P = 0.043) compared to the other etiologies. The rate of rebleeding, persistent bleeding or anemia in patients with positive, equivocal and negative CE results were 5%, 0% and 18%, respectively (P = 0.078). All the 9 patients with rebleeding after negative CE were subsequently found to be from hematologic disorders (4), colonic diverticulosis (2), colonic Dieulafoy’s (1), hemorrhoid (1) and hemosuccus pancreaticus (1). Results of CE had a positive impact on the patients’ management in 35% of the patients whose results were positive, but none on the patients whose results were equivocal or negative CE (P < 0.001).
CONCLUSION: In Thai OGIB patients, CE had low yield and small bowel ulcer was most common. Positive CE impacted managements and outcomes. Negative CE caused low rebleeding.
Collapse
Affiliation(s)
- Supot Pongprasobchai
- Supot Pongprasobchai, Songla Chitsaeng, Tawesak Tanwandee, Sathaporn Manatsathit, Udom Kachintorn, Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | | | | | | | | |
Collapse
|
53
|
Manno M, Riccioni ME, Cannizzaro R, Andreoli A, Marmo R, Pennazio M. Diagnostic and therapeutic yield of single balloon enteroscopy in patients with suspected small-bowel disease: results of the Italian multicentre study. Dig Liver Dis 2013; 45:211-5. [PMID: 23157975 DOI: 10.1016/j.dld.2012.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 10/08/2012] [Accepted: 10/11/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Limited data are available on the clinical impact of single balloon enteroscopy. AIMS To evaluate the diagnostic and therapeutic yield of single balloon enteroscopy in patients with suspected small bowel disease. METHODS Data on patients with suspected small bowel disease based on non-invasive imaging, who were subjected sequentially to enteroscopy were prospectively collected. RESULTS 131 procedures were performed in 111 patients. The mean procedure time was 61±33min for the oral approach, and 78±41min for the anal approach. The mean insertion depth was 223±93cm beyond the ligament of Treitz, and 96±56 beyond the ileo-cecal valve. A diagnosis suspected with prior small bowel tests was confirmed in 82 patients, confidently excluded in 20, while in 9 the suspected area was not reached. Total enteroscopy was deemed clinically unnecessary in 94 patients; when total enteroscopy was attempted, it was achieved in 8 out 17 patients. Endoscopic therapeutic interventions were performed in 39 patients, medical treatment was started in 30, whereas 18 underwent to surgery. No major complications were registered. CONCLUSIONS This study shows that single balloon enteroscopy appears to be an helpful and safe procedure with a high clinical impact, especially when it is placed in decision-making as a third level examination.
Collapse
Affiliation(s)
- Mauro Manno
- Gastroenterology and Digestive Endoscopy Unit, New S.Agostino-Estense Civil Hospital, Baggiovara di Modena (Mo), Italy
| | | | | | | | | | | |
Collapse
|
54
|
Shim KN, Moon JS, Chang DK, Do JH, Kim JH, Min BH, Jeon SR, Kim JO, Choi MG. Guideline for capsule endoscopy: obscure gastrointestinal bleeding. Clin Endosc 2013; 46:45-53. [PMID: 23423225 PMCID: PMC3572350 DOI: 10.5946/ce.2013.46.1.45] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 04/17/2012] [Accepted: 04/25/2012] [Indexed: 02/07/2023] Open
Abstract
Capsule endoscopy (CE) is considered as a noninvasive and reliable diagnostic tool of examining the entire small bowel. CE has been performed frequently at many medical centers in South Korea; however, there is no evidence-based CE guideline for adequate diagnostic approaches. To provide accurate information and suggest correct testing approaches for small bowel disease, the guideline on CE was developed by the Korean Gut Image Study Group, a part of the Korean Society of Gastrointestinal Endoscopy. Operation teams for developing the guideline were organized into four areas: obscure gastrointestinal bleeding, small bowel preparation, Crohn's disease, and small bowel tumor. A total of 20 key questions were selected. In preparing this guideline, MEDLINE, Cochrane library, KMbase, KISS, and KoreaMed literature searches were performed. After writing a draft of the guideline, opinions from various experts were reflected before approving the final document. The guideline should be regarded as recommendations only to gastroenterologists in providing care to their patients. These are not absolute rules and should not be construed as establishing a legal standard of care. Although further revision may be necessary as new data appear, this guideline is expected to play a role for adequate diagnostic approaches of various small bowel diseases.
Collapse
Affiliation(s)
- Ki-Nam Shim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
55
|
Peter S. Unfolding the plot of obscure gastrointestinal bleeding: excellent or elementary? Clin Gastroenterol Hepatol 2012; 10:1386-8. [PMID: 22944731 DOI: 10.1016/j.cgh.2012.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 08/20/2012] [Indexed: 02/07/2023]
|
56
|
Dye CE, Gaffney RR, Dykes TM, Moyer MT. Endoscopic and radiographic evaluation of the small bowel in 2012. Am J Med 2012; 125:1228.e1-1228.e12. [PMID: 23062406 DOI: 10.1016/j.amjmed.2012.06.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 06/26/2012] [Accepted: 06/26/2012] [Indexed: 02/08/2023]
Abstract
Traditionally, the diagnosis of small bowel disorders has been challenging secondary to the small intestine's length, tortuosity, and anatomic location. Recent technologic advancements in the field of enteroscopy and radiographic imaging have facilitated a more thorough endoscopic evaluation of patients with small bowel disease ranging from obscure gastrointestinal bleeding to inflammatory bowel disease and small bowel tumors. Such developments have made it possible to avoid invasive surgical procedures in certain clinical scenarios where they were previously the gold standard. In this review, we report an update on the diagnostic and management approach to patients with small bowel disease, emphasizing the advantages and limitations of the latest modalities now available to primary care physicians and gastroenterologists for evaluating patients with presumed disease of the small intestine.
Collapse
Affiliation(s)
- Charles E Dye
- Division of Gastroenterology/Hepatology, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | | | | | | |
Collapse
|
57
|
Sanaka MR, Navaneethan U, Kosuru B, Yerneni H, Lopez R, Vargo JJ. Antegrade is more effective than retrograde enteroscopy for evaluation and management of suspected small-bowel disease. Clin Gastroenterol Hepatol 2012; 10:910-6. [PMID: 22610006 DOI: 10.1016/j.cgh.2012.04.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 04/02/2012] [Accepted: 04/26/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Antegrade and retrograde enteroscopy are useful for evaluating the proximal and distal small bowel, respectively. We compared the diagnostic yield, therapeutic yield, and complications of antegrade and retrograde enteroscopy. METHODS We performed a retrospective review of a prospectively maintained database of patients who underwent small-bowel enteroscopy at our institution from January 2008 to August 2009. All enteroscopies were performed using single-balloon enteroscopy (SBE), double-balloon enteroscopy (DBE), or spiral enteroscopy (SE). A total of 250 enteroscopies were performed; 182 were antegrade (91 SBE, 52 DBE, and 39 SE) and 68 were retrograde (23 SBE, 37 DBE, and 8 SE). The mean age of the patients was 61.5 ± 15.8 years. RESULTS The most common indication for small-bowel endoscopy was obscure gastrointestinal bleeding (n = 83). The diagnostic yield was significantly higher for antegrade than retrograde enteroscopy (63.7% vs 39.7%; P < .001). Antegrade procedures were of shorter duration than retrograde enteroscopy (44.3 ± 22.0 vs 58.9 ± 29.7 min; P < .001), and the mean depth of maximal insertion was significantly greater with antegrade endoscopy (231.8 ± 122.1 vs 103.4 ± 102.8 cm; P < .001). The therapeutic yield also was significantly higher for anterograde enteroscopy than retrograde enteroscopy (55.5% vs 44.1%; P < .001). There were no significant differences in complications. CONCLUSIONS Antegrade enteroscopy appears to provide a higher diagnostic and therapeutic yield than retrograde enteroscopy in patients with suspected small-bowel disease.
Collapse
Affiliation(s)
- Madhusudhan R Sanaka
- Department of Gastroenterology, Digestive Disease Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | | | | | | | | | | |
Collapse
|
58
|
Teshima CW. Small bowel endoscopy for obscure GI bleeding. Best Pract Res Clin Gastroenterol 2012; 26:247-61. [PMID: 22704568 DOI: 10.1016/j.bpg.2012.01.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 01/19/2012] [Indexed: 01/31/2023]
Abstract
Advancements in small bowel endoscopy have revolutionized the investigation and management of obscure GI bleeding. Capsule endoscopy and double balloon endoscopy, followed more recently by single balloon endoscopy and spiral enteroscopy, have progressed into established technologies that have now become integrated within clinical practice. As such, small bowel endoscopy research has matured to focus less on immediate endoscopic findings and ever increasingly on important clinical outcomes with long-term follow-up. The purpose of this paper is to review the role of small bowel endoscopy in obscure GI bleeding, while providing insights that may help guide clinicians in their decision-making.
Collapse
Affiliation(s)
- Christopher W Teshima
- Division of Gastroenterology, University of Alberta, 1-51 Zeidler Ledcor Centre, University of Alberta Hospital Edmonton, Alberta T6G 2X8, Canada.
| |
Collapse
|
59
|
Kaffes AJ. Advances in modern enteroscopy therapeutics. Best Pract Res Clin Gastroenterol 2012; 26:235-46. [PMID: 22704567 DOI: 10.1016/j.bpg.2012.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 02/24/2012] [Accepted: 03/08/2012] [Indexed: 02/07/2023]
Abstract
Advances in modern enteroscopy have been largely due to endoscope development but also through the improved availability of endoscopic accessories along with improved understanding in their application. Device assisted enteroscopy began with the double balloon system in 2001 and was quickly followed by single balloon enteroscopy and spiral enteroscopy. These tools revolutionised deep small bowel endoscopy and allowed for the delivery of virtually all known therapeutic endoscopy intervention to almost all segments of the small bowel. This review covers the types of interventions in regards to indications, methods and their safety profiles as well as reviewing the various device assisted endoscopes available and their attributes.
Collapse
Affiliation(s)
- Arthur John Kaffes
- Royal Prince Alfred Hospital, AW Morrow Gastroenterology and Liver Centre, Gastroenterologist, Missenden Rd, Camperdown, NSW 2050, Australia.
| |
Collapse
|
60
|
Abstract
Now, more than 10 years after the approval of video capsule endoscopy (VCE), the technology has become an essential component in the management of several clinical conditions. Currently, two capsules are approved in the USA for visualizing the small bowel mucosa, one capsule is authorized for oesophageal assessment and several others are in use or under evaluation worldwide. New investigations have focused on optical improvements, advances in intestinal cleansing and risk reduction strategies to optimize VCE methodologies in clinical care. Established indications diagnosed using VCE include unexplained gastrointestinal bleeding, small bowel Crohn's disease (in adults and children >10 years old), localization of small bowel tumours and a broad range of miscellaneous abnormalities. Investigations are ongoing to determine the utility of VCE in colon cancer screening, assessment of oesophageal disorders and diagnosis of coeliac disease. Active research is in progress into ways to improve the efficacy of VCE recording interpretation, prolong imaging time and further enhance optics and imaging methods. To expand the potential utility of VCE, novel devices that can manoeuvre within or insufflate the gut lumen, tag or biopsy suspect lesions, or target drug delivery to specific sites are in development. To facilitate these advances, consortia have been organized to promote innovative VCE technologies.
Collapse
|
61
|
Teshima CW, May G. Small bowel enteroscopy. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2012; 26:269-75. [PMID: 22590700 PMCID: PMC3352842 DOI: 10.1155/2012/571235] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Accepted: 07/25/2011] [Indexed: 12/17/2022]
Abstract
Over the past decade, the advent of capsule endoscopy and balloon-assisted enteroscopy has revolutionized the approach to small intestinal diseases. The small bowel is no longer out of reach, and has fallen within the diagnostic and therapeutic realm of the gastrointestinal endoscopist. Double-balloon enteroscopy was the first type of balloon-assisted endoscopy and is the method for which there are the most data. Single-balloon enteroscopy has since been introduced as an alternative balloon-assisted method, followed more recently by the development of spiral overtube-assisted enteroscopy. The purpose of the present article is to review these methods of small bowel enteroscopy and to discuss the latest developments. While the investigation of small bowel diseases cannot be addressed without considering the central role of capsule endoscopy, a detailed assessment is beyond the scope of the present article, and capsule endoscopy will only be discussed as it pertains to enteroscopy.
Collapse
Affiliation(s)
- Christopher W Teshima
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta T6G 2X8, Canada.
| | | |
Collapse
|
62
|
Evaluating the role of small-bowel endoscopy in clinical practice: the largest single-centre experience. Eur J Gastroenterol Hepatol 2012; 24:513-9. [PMID: 22330235 DOI: 10.1097/meg.0b013e328350fb05] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE There are few centres that offer all forms of small-bowel endoscopic modalities [capsule endoscopy (CE), push enteroscopy (PE), double-balloon enteroscopy (DBE) or single-balloon enteroscopy and intraoperative enteroscopy (IOE)]. Previous investigators have suggested that DBE may be more cost-effective as the first-line investigation. We evaluated the relationship among four modalities of small-bowel endoscopy in terms of demand, diagnostic yield, patient management and tolerability. METHODS Data were collected on patients who underwent PE and IOE since January 2002, CE since June 2002 and DBE since July 2006. These included age, sex, indication of referral, comorbidity, previous investigations and diagnosis obtained, including subsequent management change. RESULTS Demand for CE and DBE increased every year. A total of 1431 CEs, 247 PEs, 102 DBEs and 17 IOEs were performed over 93 months. The diagnostic yield was 88% for IOE compared with 34.6% for CE, 34.5% for PE and 43% for DBE (P<0.001). Management was altered by CE in 25%, by PE in 19% and by DBE in 33% of patients. However, 44% of patients who underwent DBE found the procedure difficult to tolerate. In 2009, for every 17 CEs performed, one patient underwent DBE locally. CONCLUSION This is the first series to report the clinical experience of four modalities of small-bowel endoscopy from a single centre. The use of CE as first-line investigation, followed by PE/DBE or IOE, is potentially both less invasive and tolerable.
Collapse
|
63
|
Chalazan B, Gostout CJ, Song LMWK, Enders FT, Rajan E. Use of Capsule Small Bowel Transit Time to Determine the Optimal Enteroscopy Approach. Gastroenterology Res 2012; 5:39-44. [PMID: 27785178 PMCID: PMC5051164 DOI: 10.4021/gr404w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2012] [Indexed: 12/22/2022] Open
Abstract
Background Capsule small bowel transit time (SBTT) is used to select the most effective enteroscopy approach when targeting capsule endoscopy (CE) findings. Aim of this study was to determine if capsule SBTT can be used to guide the choice of enteroscopy technique for reaching CE abnormalities. Methods Single center, retrospective study involving 60 patients. Data were abstracted from medical records of patients with abnormal CE who proceeded to enteroscopy which included push enteroscopy (PE) single balloon enteroscopy (SBE) and double balloon enteroscopy (DBE). Results Ninety five findings were documented on CE with presumed identification of 56 (59%) of these abnormalities by enteroscopy. Majority were angioectasias on CE (42%) and enteroscopy (59%). Optimal cutoff values for selection of enteroscopy procedure were: 0-21% SBTT for PE (80% sensitivity, 74% specificity, 83% PPV); 0 - 36% SBTT for antegrade SBE (93% sensitivity, 40% specificity, 82% PPV); 0 - 57% SBTT for antegrade DBE (75% sensitivity, 80% specificity, 75% PPV); and 74 - 100% SBTT for retrograde DBE (88% sensitivity, 78% specificity, 78% PPV). Conclusion Capsule SBTT may be used to guide the selection of enteroscopy approach. PE, antegrade SBE, antegrade DBE and retrograde DBE are optimal when abnormalities on CE are seen at ≤ 21%, ≤ 36%, ≤ 57% and ≥ 74% SBTT respectively.
Collapse
Affiliation(s)
- Brandon Chalazan
- Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, USA
| | - Christopher J Gostout
- Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, USA
| | - Louis M Wong Kee Song
- Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, USA
| | - Felicity T Enders
- Health Sciences Research, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, USA
| | - Elizabeth Rajan
- Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, USA
| |
Collapse
|
64
|
Teshima CW, Aktas H, van Buuren HR, Kuipers EJ, Mensink PB. Retrograde double balloon enteroscopy: comparing performance of solely retrograde versus combined same-day anterograde and retrograde procedure. Scand J Gastroenterol 2011; 46:220-6. [PMID: 20923379 DOI: 10.3109/00365521.2010.521892] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Retrograde double balloon enteroscopy (DBE) is important for evaluating the distal small bowel, but it is more challenging compared to the oral route. Optimizing small bowel insertion may enhance the diagnostic utility of the examination. We sought to determine if insertion depths achieved with retrograde DBE when performed as an isolated procedure differed significantly from when performed immediately following anterograde DBE. MATERIAL AND METHODS A retrospective analysis was conducted of all retrograde DBE procedures performed at our center with comparisons made between "distal-only" DBE without preceding anterograde DBE and "combined" DBE after a prior same-day anterograde DBE. RESULTS Two hundred ninety retrograde DBE procedures were performed in 264 patients over 5 years. Success of terminal ileal intubation exceeded 95%. The mean insertion depth into the distal small bowel differed significantly with 112 cm (95% CI 95-129) in the "distal-only" group and 92 cm (95% CI 85-98) in the "combined" group (p = 0.01), with a trend toward a corresponding increased diagnostic yield of 48% versus 37%, respectively (p = 0.15). Multivariate regression analysis identified both insertion route strategy (distal-only > combined; p = 0.01) and type of DBE endoscope (diagnostic > therapeutic; p = 0.02) as significant predictors of retrograde insertion depth. CONCLUSIONS The insertion depth of retrograde DBE is significantly greater when carried out as a separate distal procedure and not in combination with a preceding anterograde DBE, and when performed using a diagnostic as opposed to the therapeutic DBE endoscope. This increased retrograde depth of insertion may be associated with an increased diagnostic yield.
Collapse
Affiliation(s)
- Christopher W Teshima
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
65
|
Li XB, Dai J, Chen HM, Zhuang J, Song Y, Gao YJ, Ge ZZ. A novel modality for the estimation of the enteroscope insertion depth during double-balloon enteroscopy. Gastrointest Endosc 2010; 72:999-1005. [PMID: 21034900 DOI: 10.1016/j.gie.2010.07.045] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 07/22/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND Until now, the insertion depth of the enteroscope during double-balloon enteroscopy (DBE) could only be estimated. However, the currently available methods have limitations, and development of newer, simple, and accurate modalities is needed. OBJECTIVE To evaluate the accuracy of a novel method for evaluation of enteroscope insertion depth during DBE. DESIGN Prospective, single-center cohort study. SETTING Tertiary referral university hospital. PATIENTS Fifty-one patients who had lesions found during 41 antegrade and 10 retrograde DBEs and treated by surgery were enrolled in this study. INTERVENTIONS The length of the ligament of Treitz/ileocecal valve lesion was estimated by adding the forward enteroscope length during each cycle of passage and by calculating the overtube insertion length (every 5 cm of overtube advancement means 40 cm of enteroscope advancement based on preliminary observations) during DBE, respectively, and was evaluated at surgery. MAIN OUTCOME MEASUREMENTS The length from the ligament of Treitz/ileocecal valve to the lesion. RESULTS Surgical evaluation was used as the standard. Regardless of insertion route, the mean difference from surgery in evaluation of enteroscope insertion length between using the enteroscope method and the overtube method was 19 cm (range 0-50 cm) and 17 cm (range 0-60 cm), respectively (P > .05). LIMITATIONS Small number of patients with a case series study design. CONCLUSIONS Calculating the length of the overtube passage is accurate, and it is simple to estimate the insertion depth of the enteroscope during DBE, which is useful in clinical practice.
Collapse
Affiliation(s)
- Xiao-Bo Li
- Department of Gastroenterology, Shanghai Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Institute of Digestive Disease Shanghai, China
| | | | | | | | | | | | | |
Collapse
|
66
|
Girelli CM, Maiero S, Porta P, Cannizzaro R. Small bowel capsule endoscopy performance in octogenarians: a case-control study. J Gerontol A Biol Sci Med Sci 2010; 66:68-73. [PMID: 20974730 DOI: 10.1093/gerona/glq186] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Capsule endoscopy is a high-sensitive tool for the investigation of suspected small bowel disorders, but its effectiveness in elderly patients is unknown. We sought to determine capsule endoscopy feasibility and diagnostic yield in octogenarians. PATIENTS AND METHODS Records of patients ≥ 80 years old (Group A) were retrieved from a database of 827 consecutive capsule endoscopy performed on as many patients. Capsule endoscopy failures, complications, diagnostic yield, and findings were recorded and compared with those of patients younger than 80 (Group B), randomly extracted from the same database in a > 2:1 ratio. RESULTS Group A consisted of 79 patients, 84 ± 6 years old and Group B of 188, 44 ± 11 years old (p < .0001). We visualized the entire small bowel in 59 (74.6%) patients of Group A and in 169 (89%) of Group B (odds ratio = 0.33, 95% confidence interval: 0.16-0.66, p = .0025), mainly for capsule failures in reaching the duodenum; this event occurred in 10 patients of Group A and in 3 of Group B (odds ratio = 9, 95% confidence interval: 2.4-33.4, p = .0004). The rate of adverse events and diagnostic yield did not differ between the two groups. Inflammatory and neoplastic lesions were more common in Group A (odds ratio = 2.60, 95% confidence interval: 1.07-6.28, p = .03 and odds ratio = 2.01, 95% confidence interval: 1.02-3.97, p = .04, respectively). CONCLUSIONS In octogenarians, small bowel capsule endoscopy may be troublesome for capsule failure in reaching the duodenum. However, the diagnostic yield of small bowel capsule endoscopy and the rate of clinically significant lesions are high.
Collapse
Affiliation(s)
- Carlo M Girelli
- First Division of Internal Medicine, Service of Gastroenterology and Digestive Endoscopy, Hospital of Busto Arsizio, Busto Arsizio, Italy.
| | | | | | | |
Collapse
|
67
|
Diagnosis and treatment of small bowel diseases are advanced by capsule endoscopy and double-balloon enteroscopy. Clin J Gastroenterol 2010; 3:219-25. [PMID: 26190324 DOI: 10.1007/s12328-010-0163-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 06/30/2010] [Indexed: 02/07/2023]
Abstract
In 2001, new endoscopic procedures for the small bowel, capsule endoscopy (CE) and double-balloon enteroscopy (DBE), were introduced into regular clinical practice. These methods were significant breakthroughs for imaging examination of the small bowel. The methods have different characteristics with regard to their approach into the target organ; however, common to both is the feature of enabling rapid total observation of the small bowel. CE is the first safe, non-invasive well-tolerated procedure and can be performed in any condition. The examination time is about 8 h and the patient can spend the time freely. CE can demonstrate active bleeding or neoplasm in the small bowel, which other modalities cannot detect. DBE, which was developed by Yamamoto, employs two balloons combined with an overtube and allows deeper insertion into the small bowel, and can be a modality for examination of the entire small bowel with combined oral and anal approaches. This modality enables biopsy specimens to be taken, polyps to be resected and hemostatic procedures to be performed throughout the small bowel. The understanding of small bowel disease is being extended by using CE and DBE for diagnosis. CE is considered to be superior for the first examination of the small bowel and DBE is useful for detailed examination and endoscopic therapy. Further clinical study of unknown small bowel disorders using these two modalities and algorithms for the management of small bowel disorders are required.
Collapse
|
68
|
McAlindon ME, Sanders DS, Sidhu R. Capsule endoscopy: 10 years on and in the frontline. Frontline Gastroenterol 2010; 1:82-87. [PMID: 28839553 PMCID: PMC5517174 DOI: 10.1136/fg.2009.000463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2010] [Indexed: 02/04/2023] Open
Abstract
Capsule endoscopy is a safe, simple, remote method of visualising the gastrointestinal tract without resorting to conventional endoscopic intubation or radiation exposure. In addition, the ability to visualise the small bowel mucosa directly means that it is considerably more sensitive than existing small bowel imaging modalities in detecting subtle abnormalities. It is a firstline investigative modality for suspected small bowel bleeding and is being increasingly used for detecting evidence of other small bowel diseases. In Crohn's disease, it can confirm evidence of activity without recourse to repeated endoscopic intubation or radiation but does not replace MRI and CT which are better suited to defining stricturing disease and transmural complications. The production of different capsule endoscopes to examine the oesophagus, small bowel and colon now means that almost all of the gut can be examined using this technology.
Collapse
Affiliation(s)
- M E McAlindon
- Small Bowel and Nutrition Unit, Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
| | - D S Sanders
- Small Bowel and Nutrition Unit, Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
| | - R Sidhu
- Small Bowel and Nutrition Unit, Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
| |
Collapse
|
69
|
Route selection for double-balloon endoscopy, based on capsule transit time, in obscure gastrointestinal bleeding. J Gastroenterol 2010; 45:592-9. [PMID: 20127369 DOI: 10.1007/s00535-010-0202-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 01/04/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND Double-balloon endoscopy (DBE) utilizes both oral and anal routes. The proper selection of the initial route is important for more rapid management of obscure gastrointestinal bleeding (OGIB). The aim of this retrospective study was to clarify the accuracy of the transit time of video capsule endoscopy (VCE) to the lesion as a predictive indicator for the decision on the initial DBE route. METHODS Of 172 patients who underwent both DBE and VCE, 65 who were diagnosed with small-intestinal hemorrhagic lesions by both means were enrolled. The relation between VCE transit time to the lesion and the DBE route by which the lesion was discovered was analyzed, distinguishing between 46 complete and 19 incomplete VCEs. RESULTS Among the 46 patients with a complete VCE, the transit time and position of the lesion were strongly correlated. The best cutoff values for route selection by the VCE transit time from capsule intake and from the duodenal bulb to the lesion, determined using a receiver operating characteristic (ROC) curve, were 60% and 50%, respectively, of the transit time to the cecum. At that point, the accuracy of route selection was 90% and 94%, respectively. Positions shown by VCE for ileal lesions tended to be more proximal than those shown by surgery. In the 19 patients with incomplete VCEs, the best cutoff for transit time was 180 min from the duodenal bulb. CONCLUSIONS The VCE transit time was useful for determining the route for DBE in OGIB. This parameter was most accurate when the cutoff value for the selection was half of the small-bowel transit time in the complete VCE examination.
Collapse
|