1
|
The Diagnostic Yields and Safety of Double-Balloon Enteroscopy in Obscure Gastrointestinal Bleeding and Incomplete Small Bowel Obstruction: Comparison between the Adults and Elderly. Gastroenterol Res Pract 2020; 2020:8121625. [PMID: 32411202 PMCID: PMC7201743 DOI: 10.1155/2020/8121625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/20/2020] [Indexed: 12/17/2022] Open
Abstract
Background Double-balloon enteroscopy (DBE) is widely used worldwide. However, comparisons between the diagnostic yields in adults and the elderly remain scarce. Aim The aim of this study is to compare the diagnostic yields and safety of DBE between adults and elderly with obscure gastrointestinal bleeding and incomplete small bowel obstruction. Method We retrospectively reviewed patients who underwent DBE with indication of obscure gastrointestinal bleeding or incomplete small bowel obstruction in Ruijin Hospital and classified them into adults (18–64 years old) and elderly (≥65 years old). Clinical characteristics, diagnostic yields, and postoperative complications were collected and further analyzed. Results A total of 877 DBE procedures, 729 in adults and 148 in the elderly, were performed. In the patients with OGIB, the adults showed a higher frequency of Meckel's diverticulum compared with the elderly (4.6% vs. 0.9%, P = 0.032). Angioectasia was higher in frequency in the elderly than in the adults (25.9% vs. 17.9%, P = 0.048). In patients with incomplete small bowel obstruction, the elderly were more likely to have adenocarcinoma than the adults (19.4% vs. 7.1%, P = 0.038). The adults had higher tendency to have Crohn's disease than the elderly (23.4% vs. 8.3%, P = 0.045). Most of the postoperative complications were mild. The adults and elderly displayed comparable tolerance to DBE (P > 0.05) Conclusion DBE has a high diagnostic yield in small bowel disorders, and a slight difference in disease spectrum was observed between the adults and elderly. DBE can be well-tolerated in the elderly.
Collapse
|
2
|
Pennazio M, Venezia L, Cortegoso Valdivia P, Rondonotti E. Device-assisted enteroscopy: An update on techniques, clinical indications and safety. Dig Liver Dis 2019; 51:934-943. [PMID: 31138509 DOI: 10.1016/j.dld.2019.04.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/22/2019] [Accepted: 04/23/2019] [Indexed: 12/11/2022]
Abstract
After more than 15 years since its introduction into clinical practice, indications for device-assisted enteroscopy have greatly expanded. Alongside the consolidated indications such as the diagnosis and treatment of small bowel bleeding, Crohn's disease, hereditary polyposis, small-bowel tumors and complicated celiac disease, device-assisted enteroscopy is nowadays largely used to perform endoscopic retrograde cholangiopancreatography in patients with altered anatomy, stent placement, retrieval of foreign bodies, direct insertion of jejunal feeding tubes, and in selected cases of incomplete colonoscopy. This has been made possible by the technical improvements of the enteroscopes and accessories and by the widespread use of the method. Device-assisted enteroscopy endotherapy currently offers a safe and effective alternative to major surgery and often represents the preferred option for treatment of small-bowel pathology. Its safety profile is favourable even in the elderly patient, provided that it is performed in high-volume and experienced centers. The evolution of the enteroscopy technique is a challenge for the future and could be facilitated by the new enteroscopes models. These prototypes need a thorough clinical and safety assessment especially for the complex therapeutic procedures. Large prospective, multicenter studies should be performed to assess whether the use of device-assisted enteroscopy leads to improved patients' long-term outcomes.
Collapse
Affiliation(s)
- Marco Pennazio
- University Division of Gastroenterology, Department of Medical Sciences, University of Turin, City of Health and Science, Italy.
| | - Ludovica Venezia
- University Division of Gastroenterology, Department of Medical Sciences, University of Turin, City of Health and Science, Italy
| | - Pablo Cortegoso Valdivia
- University Division of Gastroenterology, Department of Medical Sciences, University of Turin, City of Health and Science, Italy
| | | |
Collapse
|
3
|
Ribeiro Gomes AC, Pinho R, Rodrigues A, Ponte A, Carvalho J. Enteroscopy in the Elderly: Review of Procedural Aspects, Indications, Yield, and Safety. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2019; 27:18-28. [PMID: 31970236 DOI: 10.1159/000499678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/25/2019] [Indexed: 12/14/2022]
Abstract
Background As human longevity continues to increase, age-related diseases are more common, which leads to a higher use of gastroenterology services. Endoscopic procedures are generally considered to be of higher risk in the elderly with multiple comorbidities. However, some endoscopic techniques have already been proved to be well tolerated in the elderly. Summary <underline></underline>Enteroscopy enables the nonsurgical diagnosis and therapeutic management of a wide variety of small bowel diseases. Although it has been shown to be safe and effective, with high diagnostic yield and therapeutic success rate in the general population, its safety and efficacy in the elderly is largely unknown, and there are still some concerns about its use in these patients. Key Messages This review will focus on enteroscopy in elderly people, taking into account patient and procedure characteristics, indications, findings, yield, and complication rate.
Collapse
Affiliation(s)
- Ana Catarina Ribeiro Gomes
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Rolando Pinho
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Adélia Rodrigues
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ana Ponte
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - João Carvalho
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| |
Collapse
|
4
|
Holleran G, Valerii G, Tortora A, Scaldaferri F, Conti S, Amato A, Gasbarrini A, Costamagna G, Riccioni ME. The use of single balloon enteroscopy in Crohn's disease and its impact on clinical outcome. Scand J Gastroenterol 2018; 53:925-929. [PMID: 29966446 DOI: 10.1080/00365521.2018.1476914] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVES Single balloon enteroscopy (SBE) is an effective and safe modality for the diagnosis and therapeutic intervention of small bowel disorders. Its use in patients with Crohn's disease (CD) and particularly its effect on management changes in CD have not yet been determined. MATERIALS AND METHODS We performed a retrospective review of the endoscopic and clinical data available on a cohort of patients with small bowel CD who had undergone SBE to determine the diagnostic and therapeutic yield of the procedure and the initial and longer-term impact it had on clinical management. RESULTS About 52 patients have undergone SBE in our unit for the investigation of known (n = 39) or suspected (n = 13) small bowel CD with a diagnostic yield of 77% and 39%, respectively. SBE had an immediate clinical impact in 69% (n = 33) of patients, including dilatation of a stricture in 27% (n = 13), initiation or adjustment of dose of medications in 48% (n = 23), referral for surgical resection in 6% (n = 3). Moreover, the procedure permitted determining a new diagnosis of CD in 8% of the patients (n = 4), and excluding it in 8% (n = 4). Longer term follow-up was available in 34 patients (65%) which showed a significant difference in mean HBI score from 6.6 before the procedure to 4.2 after it (p < .0001). CONCLUSIONS SBE has a high diagnostic and therapeutic yield in CD and significantly impacts disease management. Careful patient selection is a key factor in optimizing its use in CD.
Collapse
Affiliation(s)
- Grainne Holleran
- a Digestive Endoscopy Unit, Catholic University of the Sacred Heart , Rome , Italy.,b Trinity College Dublin Clinical Medicine Tallaght , Dublin , Ireland
| | - Giorgio Valerii
- a Digestive Endoscopy Unit, Catholic University of the Sacred Heart , Rome , Italy
| | - Annalisa Tortora
- a Digestive Endoscopy Unit, Catholic University of the Sacred Heart , Rome , Italy
| | - Franco Scaldaferri
- c Division of Internal Medicine and Gastroenterology , Catholic University of the Sacred Heart , Rome , Italy
| | - Silvia Conti
- a Digestive Endoscopy Unit, Catholic University of the Sacred Heart , Rome , Italy
| | - Arianna Amato
- d Department of Anaesthesiology , Catholic University of the Sacred Heart , Rome , Italy
| | - Antonio Gasbarrini
- c Division of Internal Medicine and Gastroenterology , Catholic University of the Sacred Heart , Rome , Italy
| | - Guido Costamagna
- a Digestive Endoscopy Unit, Catholic University of the Sacred Heart , Rome , Italy
| | - Maria Elena Riccioni
- a Digestive Endoscopy Unit, Catholic University of the Sacred Heart , Rome , Italy
| |
Collapse
|
5
|
Ching HL, Branchi F, Sanders DS, Turnbull D, Sidhu R. Paradigm shift: should the elderly undergo propofol sedation for DBE? A prospective cohort study. Frontline Gastroenterol 2018; 9:192-199. [PMID: 30046423 PMCID: PMC6056081 DOI: 10.1136/flgastro-2017-100847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/23/2017] [Accepted: 09/02/2017] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Evaluate the safety of propofol-assisted double balloon enteroscopy (DBE) in elderly patients against a younger cohort. DESIGN Prospective cohort study. SETTING All patients undergoing DBE over a 30-month period were recruited at our tertiary centre. PATIENTS 215 procedures in 161 patients were performed. An age cut-off of 65 years and above was used to define those who were elderly. INTERVENTIONS Patients were subcategorised into four groups: elderly or young undergoing DBE with propofol or conventional sedation (with midazolam±fentanyl). MAIN OUTCOME MEASURES Patient demographics, comorbidities, procedural data, complications, diagnostic and therapeutic yield were compared. RESULTS Cardiovascular disease and a higher American Society of Anaethesiologists (ASA) status were more prevalent in elderly patients undergoing DBE with propofol (p<0.05). Common indications for DBE were occult and overt obscure gastrointestinal bleeding and suspected Crohn's disease (elderly vs young: 50.7% vs 42.3%, 17.8% vs 12% and 19.2% vs 26.1%, respectively). Diagnostic yield was higher in elderly compared with young patients (75.3% vs 58.5%, p=0.016). The most common findings in elderly and young patients were angioectasia (30.1% and. 18.3%, respectively) and ulcers (17.8% and 9.2%, respectively), while therapeutic intervention rates were comparable (42.5% vs 32.4%, p=0.18). ASA status did not affect propofol dose (p=0.55) or procedure duration (p=0.31). Tolerance scores were favourable in those receiving propofol compared with conventional sedation (p<0.05). There was no difference in complications between the four groups (p=0.17). CONCLUSION Compared with young patients, propofol-assisted DBE in the elderly is safe and has a high diagnostic yield.
Collapse
Affiliation(s)
- Hey-Long Ching
- Department of Gastroenterology, Royal Hallamshire Hospital Sheffield Teaching Hospitals, Sheffield, UK
| | - Federica Branchi
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda, Milano, Italy
| | - David S Sanders
- Department of Gastroenterology, Royal Hallamshire Hospital Sheffield Teaching Hospitals, Sheffield, UK
| | - David Turnbull
- Department of Anaesthesia, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Reena Sidhu
- Department of Gastroenterology, Royal Hallamshire Hospital Sheffield Teaching Hospitals, Sheffield, UK
| |
Collapse
|
6
|
Ivano FH, Villela IR, Miranda LFD, Nakadomari TS. ANALYSIS OF DOUBLE BALLOON ENTEROSCOPY: INDICATIONS, FINDINGS, THERAPEUTIC AND COMPLICATIONS. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2017; 30:83-87. [PMID: 29257840 PMCID: PMC5543783 DOI: 10.1590/0102-6720201700020002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 09/13/2016] [Indexed: 12/22/2022]
Abstract
Background: The double balloon enteroscopy is an important method for the endoscopic approach of the small bowel that provides diagnosis and therapy of this segment’s disorders, with low complication rate. Aim: Analysis of patients undergoing double balloon enteroscopy. The specific objectives were to establish the indications for this method, evaluate the findings by the double balloon enteroscopy, analyze the therapeutic options and the complications of the procedure. Methods: It is a retrospective analysis of 65 patients who underwent double balloon enteroscopy. Results: Sixty-five procedures were performed in 50 patients, 63.1% were women and 36.9% were men. The mean age was 50.94 years. The main indication it was gastrointestinal bleeding, followed by abdominal pain and Crohn’s disease. Most procedures were considered normal. Polyps were the most prevalent finding, followed by angioectasias and duodenitis. In 49.2% of the cases, one or more therapeutic procedures were performed, (biopsy was the most prevalent). There was only one case of acute pancreatitis, which was treated clinically. Conclusion: The enteroscopy is good and safe method for the evaluation of the small bowel, and its main indications are gastrointestinal bleeding and abdominal pain. It has low complications rates and reduces the necessity of surgery.
Collapse
Affiliation(s)
- Flávio Heuta Ivano
- Serviço de Endoscopia, Hospital Sugisawa (Endoscopy Service, Sugisawa Hospital, Curitiba, PR, Brazil
| | - Izabela Rodrigues Villela
- Serviço de Endoscopia, Hospital Sugisawa (Endoscopy Service, Sugisawa Hospital, Curitiba, PR, Brazil
| | - Lívia Fouani de Miranda
- Serviço de Endoscopia, Hospital Sugisawa (Endoscopy Service, Sugisawa Hospital, Curitiba, PR, Brazil
| | - Thaísa Sami Nakadomari
- Serviço de Endoscopia, Hospital Sugisawa (Endoscopy Service, Sugisawa Hospital, Curitiba, PR, Brazil
| |
Collapse
|
7
|
Chen Y, Liu G, Zhang T, Yang K, Yu H, Tie Y, Liang J, Zhou J, Gan H. Diagnostic yield and safety of double balloon-assisted enteroscopy in the elderly: A systematic review and meta-analysis. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
|
8
|
Cangemi DJ, Stark ME, Cangemi JR, Lukens FJ, Gómez V. Double-balloon enteroscopy and outcomes in patients older than 80. Age Ageing 2015; 44:529-32. [PMID: 25630801 DOI: 10.1093/ageing/afv003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 10/10/2014] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND double-balloon enteroscopy (DBE) is becoming more commonly used for investigation of small bowel pathology. Currently, there are limited data to describe its safety and efficacy in the population over age 65. AIM to investigate the indications, findings and outcomes of DBE performed in patients older than 80, as well as the correlation between DBE and prior capsule endoscopy (CE) findings. METHODS we retrospectively reviewed our large DBE database, including procedures from January 2006 to September 2012. Patients aged 80 or older at the time of DBE were included in the study. The indications, findings, outcomes and diagnostic yield of DBE were calculated by frequency analysis. RESULTS two hundred and fifteen DBEs were performed in 130 patients aged 80 or older. The mean age was 83.6 ± 3.03 years (range: 80-94). Twelve patients (9.2%) were assigned an American Society of Anaesthesiologists score of II prior to procedure, 102 patients (78.4%) were assigned a score of III and 16 patients (12.3%) were given a score of IV. The most common indication for DBE was obscure gastrointestinal bleeding (N = 204, 94.9%). One hundred and fourteen patients (87.7%) underwent CE prior to DBE, and correlation between findings of CE and DBE occurred in 74.6% of these patients. The overall diagnostic yield of DBE was 77.2% (N = 166). There were no immediate post-procedural complications or failed procedures. CONCLUSION DBE is a safe and effective technique for investigation of the small bowel in patients aged 80 and older. Age alone should not be a contraindication to performing DBE when clinically indicated.
Collapse
Affiliation(s)
- David J Cangemi
- Department of Internal Medicine, Mayo Clinic, 4500 San Pablo Road S, Jacksonville, FL 32224, USA
| | - Mark E Stark
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - John R Cangemi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Frank J Lukens
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Victoria Gómez
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| |
Collapse
|
9
|
Yang DH. Questions about sedation protocols for double-balloon enteroscopy. Intest Res 2015; 13:97-8. [PMID: 25691851 PMCID: PMC4316231 DOI: 10.5217/ir.2015.13.1.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/09/2015] [Accepted: 01/09/2015] [Indexed: 01/30/2023] Open
Affiliation(s)
- Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
10
|
Jeon SR. Author's Reply. Intest Res 2015; 13:99-100. [PMID: 25691852 PMCID: PMC4316232 DOI: 10.5217/ir.2015.13.1.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 01/10/2015] [Accepted: 01/12/2015] [Indexed: 11/05/2022] Open
Affiliation(s)
- Seong Ran Jeon
- Digestive Disease Center, Institute of Digestive Research, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| |
Collapse
|
11
|
Moeschler O, Mueller MK. Deep enteroscopy - indications, diagnostic yield and complications. World J Gastroenterol 2015; 21:1385-1393. [PMID: 25663758 PMCID: PMC4316081 DOI: 10.3748/wjg.v21.i5.1385] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 10/14/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
Since its introduction in 2001 capsule endoscopy opened up the small bowel for diagnostic approaches followed by double balloon enteroscopy which enabled the endoscopic community to perform therapeutic interventions in the whole small intestine. In this review the scientific developments related to indications, diagnostic yield and complications of the last years between the competing devices double ballon enteroscopy, single balloon enteroscopy and spiral enteroscopy are illustrated.
Collapse
|
12
|
Choi DH, Jeon SR, Kim JO, Kim HG, Lee TH, Lee WC, Kang BS, Cho JH, Jung Y, Kim WJ, Ko BM, Cho JY, Lee JS, Lee MS. Double-balloon enteroscopy in elderly patients: is it safe and useful? Intest Res 2014; 12:313-9. [PMID: 25374498 PMCID: PMC4214959 DOI: 10.5217/ir.2014.12.4.313] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 02/07/2023] Open
Abstract
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 ≥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.
Collapse
Affiliation(s)
- Dae Han Choi
- Department of Internal Medicine, Digestive Disease Center, Institute of Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seong Ran Jeon
- Department of Internal Medicine, Digestive Disease Center, Institute of Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jin-Oh Kim
- Department of Internal Medicine, Digestive Disease Center, Institute of Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyun Gun Kim
- Department of Internal Medicine, Digestive Disease Center, Institute of Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Tae Hee Lee
- Department of Internal Medicine, Digestive Disease Center, Institute of Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Woong Cheul Lee
- Department of Internal Medicine, Digestive Disease Center, Institute of Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Byung Soo Kang
- Department of Internal Medicine, Digestive Disease Center, Institute of Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jun-Hyung Cho
- Department of Internal Medicine, Digestive Disease Center, Institute of Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yunho Jung
- Department of Internal Medicine, Digestive Disease Center, Institute of Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Wan Jung Kim
- Department of Internal Medicine, Digestive Disease Center, Institute of Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Bong Min Ko
- Department of Internal Medicine, Digestive Disease Center, Institute of Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Joo Young Cho
- Department of Internal Medicine, Digestive Disease Center, Institute of Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Joon Seong Lee
- Department of Internal Medicine, Digestive Disease Center, Institute of Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Moon Sung Lee
- Department of Internal Medicine, Digestive Disease Center, Institute of Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| |
Collapse
|
13
|
Gurkan OE, Karakan T, Dogan I, Dalgic B, Unal S. Comparison of double balloon enteroscopy in adults and children. World J Gastroenterol 2013; 19:4726-4731. [PMID: 23922469 PMCID: PMC3732844 DOI: 10.3748/wjg.v19.i29.4726] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 03/14/2013] [Accepted: 05/10/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare results of double balloon enteroscopy (DBE) procedures in pediatric and adult patients.
METHODS: The medical files of patients who underwent DBE at Gazi University School of Medicine, Ankara, Turkey between 2009 and 2011 were examined retrospectively. Adult and pediatric patients were compared according to DBE indications, procedure duration, final diagnosis, and complications. DBE procedures were performed in an operating room under general anesthesia by two endoscopists. An oral or anal approach was preferred according to estimated lesion sites. Overnight fasting of at least 6 h prior to the start of the procedure was adequate for preprocedural preparation of oral DBE procedures. Bowel cleansing was performed by oral administration of sennosides A and B solution, 2 mL/kg, and anal saline laxative enema. The patients were followed up for 2 h after the procedure in terms of possible complications.
RESULTS: DBE was performed in 35 patients (5 pediatric and 30 adult). DBE procedures were performed for abdominal pain, chronic diarrhea, bleeding, chronic vomiting, anemia, and postoperative evaluation of anastomosis. Final diagnosis was diffuse gastric angiodysplasia (n = 1); diffuse jejunal angiodysplasia (n = 1); ulceration in the bulbus (n = 1); celiac disease (n = 1); low differentiated metastatic carcinoma (n = 1); Peutz-Jeghers syndrome (n = 1); adenomatous polyp (n = 1) and stricture formation in anastomosis line (n = 1). During postprocedural follow-up, abdominal pain and elevated amylase levels were noted in three patients and one patient developed abdominal perforation.
CONCLUSION: With the help of technological improvements, we may use enteroscopy as a safe modality more frequently in younger and smaller children.
Collapse
|
14
|
Byeon JS, Mann NK, Jamil LH, Lo SK. Double balloon enteroscopy can be safely done in elderly patients with significant co-morbidities. J Gastroenterol Hepatol 2012; 27:1831-6. [PMID: 23034065 DOI: 10.1111/j.1440-1746.2012.07284.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Performance of double balloon enteroscopy (DBE) on older patients with comorbidities is a matter of safety. We aimed to investigate the utility and safety of DBE in older patients. METHODS We retrospectively reviewed the medical records of patients 75 years or older who underwent DBE in our open-access endoscopy unit in a tertiary center. We analyzed the diagnostic yield, therapeutic intervention, and safety including complications of DBE. RESULTS Four scheduled DBEs were canceled because of poor conditions. Two hundred and fourteen DBEs were performed in 167 elderly patients. All DBEs were performed under monitored anesthesia care using intravenous propofol administered by anesthesiologists. One half of the patients were male (female : male = 80:87). The mean age of patients was 80.1 ± 3.7 years. Co-morbidity of significant chronic diseases was noted in 208 (97.2%) DBEs. Fifty-one (23.8%) DBEs were performed in patients with American Society of Anesthesiologists (ASA) physical status II, 151 (70.6%) DBEs with ASA class III, and 12 (5.6%) DBEs with ASA class IV. The most common indication was obscure gastrointestinal bleeding. The mean DBE procedure time was 131 ± 51 min. Abnormalities were detected in 129 (60.3%) DBEs with therapeutic interventions performed in 83 (38.8%) cases. Pancreatitis, hypoxia, and aspiration pneumonia developed after three (1.4%), three (1.4%), and two (0.9%) DBEs, respectively, all of which resolved with conservative care. CONCLUSIONS Double balloon enteroscopy can be done with acceptable safety in the elderly with high ASA class. DBE shows a high diagnostic yield and can deliver many therapeutic applications.
Collapse
Affiliation(s)
- Jeong-Sik Byeon
- David Geffen School of Medicine at UCLA, Cedars-Sinai Medical Center, Los Angeles, California, USA.
| | | | | | | |
Collapse
|