Carbon dioxide insufflation safety in double-balloon enteroscopy: an experimental animal study

Efficacy and safety of water-exchange enteroscopy compared to carbon dioxide insufflation during enteroscopy

INTRODUCTION

carbon dioxide (CO2) insufflation during enteroscopy reduces procedure time and subsequent symptoms and increases the insertion depth compared with room air. In colonoscopy, the water-exchange (WE) technique is associated with less pain compared with CO2 insufflation. The WE technique is not well studied in enteroscopy. The aim of this study was to compare the efficacy and safety of enteroscopy with WE and CO2.

METHODS

a prospective, comparative and observational study was performed of double balloon enteroscopies (DBE) that were randomized in two groups. The first group used WE while the second group used CO2 insufflation. The data collected was evaluated via univariate analysis and multiple logistic regression (variables with p ≤ 0.10 according to the univariate analysis).

RESULTS

forty-six DBE were included; 23 in each arm. The median age of cases was 63.5 years and 37% were female. There were no statistical differences between the groups with regard to the access route, findings, therapy and complications. Four patients (20%) in the CO2 group had adverse events (abdominal distension and pain) and one in the WE group (nausea), which was not statistically significant. The median insertion depth was greater in the CO2 group; 260 cm vs 160 cm (p = 0.048). Multiple logistic regression showed a statistically significant difference in the insertion depth using CO2 insufflation (OR 1.009, 1.001-1.017; p = 0.034).

CONCLUSIONS

DBE with a CO2 insufflation technique and WE are safe with a greater insertion depth with CO2.

Evidences supporting the vascular etiology of post-double balloon enteroscopy pancreatitis: Study in porcine model

Double balloon enteroscopy (DBE) is an endoscopic technique broadly used to diagnose and treat small bowel diseases. Among the associated complications of the oral DBE, post-procedure pancreatitis has taken the most attention due to its gravity and the thought that it might be associated to the technique itself and anatomical features of the pancreas. However, as the etiology has not been clarified yet, this paper aims to review the published literature and adds new results from a porcine animal model. Biochemical markers, histological sections and the vascular perfusion of the pancreas were monitored in the pig during DBE practice. A reduced perfusion of the pancreas and bowel, the presence of defined hypoxic areas and disseminated necrotic zones were found in the pancreatic tissue of pigs. All these evidences contribute to support a vascular distress as the most likely etiology of the post-DBE pancreatitis.

Diagnostic and Therapeutic Capability of Double-Balloon Enteroscopy in Clinical Practice

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.

Effects of carbon dioxide insufflation in balloon-assisted enteroscopy: A systematic review and meta-analysis

BACKGROUND AND AIM

The efficacy of CO2 insufflation during balloon-assisted enteroscopy remains controversial. This study aimed to perform a systematic review with meta-analysis of randomized controlled trials (RCTs) in which CO2 insufflation was compared with air insufflation in balloon-assisted enteroscopy.

METHODS

PubMed, the Cochrane library, and the Igaku-Chuo-Zasshi database were searched to identify RCTs eligible for inclusion in the systematic review. Data from the eligible studies were combined to calculate the pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs).

RESULTS

Four RCTs (461 patients) were identified. Compared with air insufflation, CO2 insufflation significantly increased intubation depth of oral enteroscopy (WMD: 55.2, 95% CI: 10.77-99.65, p = 0.015). However, there was significant heterogeneity. The intubation depth of anal enteroscopy showed no significant difference between the CO2 group and the air group. CO2 insufflation significantly reduced abdominal pain compared with air insufflation (WMD: -2.463, 95% CI: -4.452 to -0.474, p = 0.015), without significant heterogeneity. The PaCO2 or end-tidal CO2 level showed no significant difference between the CO2 group and air group.

CONCLUSIONS

Compared with air insufflation, CO2 insufflation during balloon-assisted enteroscopy caused less post-procedural pain without CO2 retention.