Diagnostic and therapeutic yield is not influenced by the timing of small-bowel enteroscopy: morning versus afternoon.

BACKGROUND: Small-bowel enteroscopies (BEs) are tedious and prolonged, and their efficacy may be affected by the timing of procedures. OBJECTIVE: We aimed to evaluate the differences in diagnostic yield, insertion depth, procedure duration, therapeutic yield, and adverse events (AEs) of enteroscopies performed in the morning versus the afternoon. DESIGN: Retrospective cohort study. SETTING: Tertiary referral center. PATIENTS: Patients who underwent BE for suspected small-bowel disease at a single institution between January 2008 and August 2009. MAIN OUTCOME MEASUREMENT: Differences in diagnostic yield, insertion depth, procedure duration, therapeutic yield, and AEs between morning (started before noon) and afternoon (after noon) procedures. RESULTS: A total of 250 enteroscopies were performed on 250 patients, of which 125 patients (50%) underwent a procedure in the morning and 125 patients (50%) underwent the procedure in the afternoon. The diagnostic yield with anterograde enteroscopy was the same in both the morning and afternoon (63.7% and 63.7%, respectively; P = .99). The procedure durations were also similar (42.4 ± 21.5 minutes vs 46.2 ± 22.4 minutes, respectively; P = .25). Similarly the diagnostic yield with retrograde enteroscopy was similar in morning and afternoon (44.1% and 35.3%, respectively; P = .46). However, the procedure durations of retrograde BE were significantly shorter in the morning compared with the afternoon (51.3 ± 21.3 minutes vs 66.6 ± 32.9 minutes, respectively; P = .03). Therapeutic yield and AEs were similar. LIMITATIONS: Retrospective study. CONCLUSIONS: The timing of procedure, morning versus afternoon, did not affect the diagnostic and therapeutic efficacy of BE in patients with suspected small-bowel disease.

Multiple pancreatic pseudocysts treated with endoscopic transpapillary drainage.

Management of a solitary pancreatic pseudocyst with endoscopic transpapillary stent drainage is a well recognized treatment modality. Endoscopic options are however limited in the presence of multiple pancreatic pseudocysts. Conventionally surgery has been the mainstay of treatment in this situation. In this case report, we present a patient with multiple pancreatic pseudocysts who was successfully treated via transpapillary placement of pancreatic duct stent.

The clinical utility of single-balloon enteroscopy: a single-center experience of 172 procedures.

BACKGROUND: Single-balloon enteroscopy (SBE) is a novel endoscopic technique designed to evaluate and treat small-bowel disease. Although there is substantial literature addressing double-balloon enteroscopy and its impact on the diagnosis and management of small-bowel disease, there are limited data available on the clinical utility of SBE. OBJECTIVES: To evaluate the clinical utility and diagnostic impact of SBE in a large cohort of patients at a single tertiary center. DESIGN: Single-center, retrospective study. SETTING: Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio. PATIENTS: A total of 161 patients were referred for SBE from January 2006 to August 2008. MAIN OUTCOME MEASUREMENTS: Demographic, clinical, procedural, and outcome data were collected and analyzed. RESULTS: A total of 161 patients underwent a total of 172 procedures. Antegrade and retrograde approaches were used in 83% and 17% of subjects, respectively. The average insertion depth using the antegrade approach was 132 cm beyond the ligament of Treitz (range 20-400 cm). The average insertion depth using the retrograde approach was 73 cm above the ileocecal valve (range 10-160 cm). The average procedure time was 40 minutes overall, 38 minutes (range 12-90) antegrade and 48 minutes (range 28-89) retrograde. Fluoroscopy was used in 20 cases (12%). Diagnostic yield was 58% (99/172); 42% (72/172) were therapeutic cases. There were no significant complications. LIMITATIONS: Single-center, retrospective study. CONCLUSIONS: SBE demonstrated a high diagnostic yield and frequently provided useful therapeutic intervention. It seems to be a safe and effective method for performing deep enteroscopy.

Single-balloon enteroscopy.

Single-balloon enteroscopy has emerged as a viable alternative to double-balloon enteroscopy in the management of small bowel disease. Technically, it is easier to perform, may be more efficient, and in the limited literature available, seems to provide similar diagnostic and therapeutic yield when compared with double-balloon enteroscopy. This review provides up-to-date views on this emerging technology and its application.

Small bowel enteroscopy.

For the examination of the small bowel in patients with suspected small bowel bleeding, endoscopic tools to perform deep enteroscopy have become essential. Double balloon enteroscopy has gained worldwide acceptance as an endoscopic technique that can be used safely and effectively to provide complete examination of the small bowel, offer therapeutic intervention, and favorably affect clinical outcomes. Single balloon enteroscopy seems to have utility similar to that of the double balloon system. Preliminary experience with a novel overtube device using either the single or double balloon enteroscope has suggested that this may be a very viable approach to deep enteroscopy. Collectively, these are remarkable innovations that allow access to portions of the small bowel that were previously only available by intraoperative enteroscopy or laparotomy. On the basis of the available data, each of these procedures seems to have unique merits, is generally safe and well tolerated, and is highly likely to be clinically beneficial.