Safety and efficacy of the novel motorized power spiral enteroscopy: A single-center experience.

Objective: Evaluation and management of small bowel disorders have always been challenging due to the limitations of the existing technology. Motorized power spiral enteroscopy (PSE) is an innovative new technique that offers easier, faster, and more complete small bowel evaluation with the ability to perform therapeutics. We aimed to evaluate the safety and efficacy of PSE in various indications. Methods: Retrospective analysis of prospectively collected data of consecutive patients, who underwent PSE at a tertiary care center. Primary outcome measures were technical success rate, pan-enteroscopy rate, diagnostic and therapeutic yield, and the secondary outcomes measures were the depth of maximal insertion, median insertion time, and adverse events. Results: Fifty-four patients (mean age of 49.38 ± 16.26 years) underwent PSE for small bowel evaluation. Technical success rate was 95.55% (antegrade route) and 93.10% (retrograde route).  Pan-enteroscopy rate is 46.29% and antegrade enteroscopy to the cecum was achieved in eight patients.  Overall diagnostic and therapeutic yields were 85.18% and 30.76%, respectively. The most common findings were ulcero-stricturing lesions (51.92%) followed by vascular lesions (9.61%). The most common histopathologic diagnosis was Crohn's disease in 29.62%. Median depth of maximal insertion was 400 cm (range 150-550 cm; antegrade route) and 180 cm (range 50-350 cm; retrograde route). The median insertion time to depth of maximal insertion was 70 min (range 30-110 min; antegrade route) and 45 min (range 20-70 min; retrograde route).  PSE-associated major adverse events occurred in one patient and minor adverse events were seen in 48.14%. Conclusion: PSE is a safe and effective modality for the evaluation of small bowel disorders with a high diagnostic yield.

Clinical profile, diagnostic yield, and procedural outcomes of single balloon enteroscopy: A tertiary care hospital experience.

BACKGROUND: Single balloon enteroscopy (SBE) allows ease of access for small bowel visualization and has multiple diagnostic and therapeutic indications. It provides the advantage of performing various therapeutic interventions alongside the diagnostic procedure. SBE has also been considered a relatively safe procedure with no major complications. AIM: To investigate the indications, safety, and clinical yield of SBE, and determine its effect on disease outcome. METHODS: A retrospective, descriptive study was conducted at a tertiary care hospital in Karachi, Pakistan. Medical records of 56 adult patients (≥ 18 years) who underwent SBE between July 2013 and December 2021 were reviewed and data were collected using a structured proforma. A descriptive analysis of the variables was performed using Statistical Package of Social Sciences Version 19. Results are reported as the mean ± SD for quantitative variables and numbers and percentages for qualitative variables. Missing data are reported as unknown. RESULTS: A total of 56 patients who underwent 61 SBE procedures were included. The mean age was 50.93 ± 16.16 years, with 53.6% of them being males. Hypertension (39.3%) and diabetes mellitus (25.0%) were the most common pre-existing comorbidities. Obscure gastrointestinal bleed (39.3%) was the most common indication for enteroscopy, followed by chronic diarrhea (19.7%) and unexplained anemia (16.4%). The majority of procedures were performed in the endoscopy suite (90.2%) under monitored anaesthesia care (93.4%). Most procedures were diagnostic (91.8%) and completed without complications (95.1%). The depth of examination ranged from 95 cm to 500 cm with a mean of 282.05 ± 90.04 cm. The most common findings were inflammation and ulcerations (29.5%), followed by masses (19.7%) and vascular malformations (14.8%). As a result of the findings, a new diagnosis was made in 47.5% of the cases and a previous one was ruled out in 24.6% of them; 65.6% of the cases had a change in management. CONCLUSION: SBE is a suitable modality for investigating diseases in the small bowel. It is shown to be technically efficient and reasonably safe and is associated with high diagnostic and therapeutic yield.

Diagnostic value of OMOM capsule endoscopy for small bowel diseases in adults.

The present study aimed to determine the diagnostic yield of OMOM capsule endoscopy for small bowel diseases in adults. A total of 89 patients, including 45 cases of obscure abdominal pain, 22 of chronic diarrhea, 18 of obscure gastrointestinal bleeding and 4 of obscure anemia were enrolled in the present study. The transit time of the endoscopy capsule in the digestive tract was recorded and the testing results were analyzed. All detections were completed except for four capsule retentions and the completion rate was 95.51%. The average transit time of the endoscopy capsule in the esophagus, stomach and small intestine was 62.18±64.23 sec, 67.46±63.13 and 346.53±102.81 min, respectively. Of the 89 patients, 54 (60.67%) were found to have lesions, among which 19 had mucosal erosion (21.35%), 15 had anabrosis (16.85%), 9 were diagnosed with polyps (10.11%), 5 with angiodysplasia (5.62%); furthermore, tumors were identified in 5 patients (5.62%) and ancylostomiasis in 1 patient (1.12%). The results confirmed the feasibility and validity of OMOM capsule endoscopy for diagnosing small bowel diseases in adults.

Capsule endoscopy and single-balloon enteroscopy in small bowel diseases: Competing or complementary?

AIM: To evaluate diagnostic yields of capsule endoscopy (CE) and/or single-balloon enteroscopy (SBE) in patients with suspected small bowel diseases. METHODS: We retrospectively analyzed 700 patients with suspected small bowel diseases from September 2010 to March 2016. CE, SBE, or SBE with prior CE was performed in 401, 353, and 47 patients, respectively. Data from clinical and endoscopy records were collected for analysis. Indications, procedure times, diagnostic yields, and complications were summarized and evaluated. RESULTS: The overall diagnostic yield for the CE group was 57.6%. The diagnostic yield of CE in patients with obscure gastrointestinal bleeding (OGIB) was significantly greater than that in patients with no bleeding (70.5% vs 43.8%, P < 0.01). The overall diagnostic yield of SBE was 69.7%. There was no difference in the diagnostic yield of SBE between patients with OGIB and those with no bleeding (72.5% vs 68.9%, P = 0.534). Forty-seven patients underwent CE prior to SBE. Among them, the diagnostic yield of SBE with positive findings on prior CE was 93.3%. In addition, SBE detected two cases with superficial ulcer and erosive lesions in the small bowel, which were missed by CE. However, one case with lymphoma and two with Crohn's disease were not confirmed by SBE. The rate of capsule retention was 2.0%. There were no significant complications during or after SBE examinations. CONCLUSION: SBE is a safe and effective technique for diagnosing small bowel diseases. SBE with prior CE seemed to improve the diagnostic yield of small bowel diseases.

Virtual chromoendoscopy improves the diagnostic yield of small bowel capsule endoscopy in obscure gastrointestinal bleeding.

BACKGROUND: Small bowel capsule endoscopy represents the initial investigation for obscure gastrointestinal bleeding. Flexible spectral imaging colour enhancement (FICE) is a virtual chromoendoscopy technique designed to enhance mucosal lesions, available in different settings according to light wavelength-- FICE1, 2 and 3. AIMS: To compare the diagnostic yield of FICE1 and white light during capsule endoscopy in patients with obscure gastrointestinal bleeding. METHODS: Retrospective single-centre study including 60 consecutive patients referred for small bowel capsule endoscopy for obscure gastrointestinal bleeding. Endoscopies were independently reviewed in FICE1 and white light; findings were then reviewed by another researcher, establishing a gold standard. Diagnostic yield was defined as the presence of lesions with high bleeding potential (P2) angioectasias, ulcers or tumours. RESULTS: Diagnostic yield using FICE1 was significantly higher than white light (55% vs. 42%, p=0.021). A superior number of P2 lesions was detected with FICE1 (74 vs. 44, p=0.003), particularly angioectasias (54 vs. 26, p=0.002), but not ulcers or tumours. CONCLUSIONS: FICE1 was significantly superior to white light, resulting in a 13% improvement in diagnostic yield, and potentially bleeding lesions particularly angioectasias were more often observed. Our results support the use of FICE1 while reviewing small bowel capsule endoscopy for obscure gastrointestinal bleeding.

A Retrospective Analysis of Capsule Endoscopy in 573 Cases / 胃肠病学

Background:Capsule endoscopy has been demonstrated to be an effective diagnostic tool for small bowel diseases in a series of small sample researches. However,the results need to be verified by large sample studies. Aims:To investigate the diagnostic performance and safety of capsule endoscopy for small bowel diseases. Methods:Consecutive patients undergoing capsule endoscopy for suspected small bowel diseases from May 2008 to Apr. 2013 in Nanjing General Hospital of Nanjing Military Command of PLA were collected and analyzed retrospectively. Results:A total of 573 patients were enrolled,the overall success rate of the examination was 99. 13%(568 / 573)and the overall completion rate was 88. 38%(502 / 568). The mean time of capsule passing the pylorus was 43. 45 min,and that of passing the small bowel was 287. 21 min. The overall detection rate of small bowel lesions was 53. 52%(304 / 568)and the overall diagnostic rate was 51. 06%(290 / 568). Both the detection rate and diagnostic rate in patients with obscure gastrointestinal bleeding(OGIB) were significantly higher than those in patients with obscure abdominal pain and chronic diarrhea(64. 26% and 62. 46%vs. 41. 72% and 39. 07% ,and 32. 14% and 27. 38% ,P all < 0. 05). Small bowel lesions detected by capsule endoscopy included angiopathy(21. 38% ),ulceration(20. 72% ),neoplasms(14. 47% ),erosion(11. 84% ),and Crohn’s disease(11. 18%),etc. Capsule retention occurred in 2. 29%(13/568)of the patients,and one acute intestinal obstruction and 2 perforations were observed. Conclusions:Capsule endoscopy is a safe and effective diagnostic modality for small bowel diseases. OGIB is the most common indication for capsule endoscopy,and capsule endoscopy is also helpful for evaluation of established or suspected Crohn’s disease.

PillCam COLON 2 in Crohn's disease: A new concept of pan-enteric mucosal healing assessment.

AIM: To evaluate mucosal healing in patients with small bowel plus colonic Crohn's disease (CD) with a single non-invasive examination, by using PillCam COLON 2 (PCC2). METHODS: Patients with non-stricturing nonpenetrating small bowel plus colonic CD in sustained corticosteroid-free remission were included. At diagnosis, patients had undergone ileocolonoscopy to identify active CD lesions, such as ulcers and erosions, and small bowel capsule endoscopy to assess the Lewis Score (LS). After ≥ 1 year of follow-up, patients underwent entire gastrointestinal tract evaluation with PCC2. The primary endpoint was assessment of CD mucosal healing, defined as no active colonic CD lesions and LS < 135. RESULTS: Twelve patients were included (7 male; mean age: 32 years), and mean follow-up was 38 mo. The majority of patients (83.3%) received immunosuppressive therapy. Three patients (25%) achieved mucosal healing in both the small bowel and the colon, while disease activity was limited to either the small bowel or the colon in 5 patients (42%). It was possible to observe the entire gastrointestinal tract in 10 of the 12 patients (83%) who underwent PCC2. CONCLUSION: Only three patients in sustained corticosteroid-free clinical remission achieved mucosal healing in both the small bowel and the colon, highlighting the limitations of clinical assessment when stratifying disease activity, and the need for pan-enteric endoscopy to guide therapeutic modification.

Impact of fecal occult blood on obscure gastrointestinal bleeding: observational study.

AIM: To elucidate the association between small bowel diseases (SBDs) and positive fecal occult blood test (FOBT) in patients with obscure gastrointestinal bleeding (OGIB). METHODS: Between February 2008 and August 2013, 202 patients with OGIB who performed both capsule endoscopy (CE) and FOBT were enrolled (mean age; 63.6 ± 14.0 years, 118 males, 96 previous overt bleeding, 106 with occult bleeding). All patients underwent immunochemical FOBTs twice prior to CE. Three experienced endoscopists independently reviewed CE videos. All reviews and consensus meeting were conducted without any information on FOBT results. The prevalence of SBDs was compared between patients with positive and negative FOBT. RESULTS: CE revealed SBDs in 72 patients (36%). FOBT was positive in 100 patients (50%) and negative in 102 (50%). The prevalence of SBDs was significantly higher in patients with positive FOBT than those with negative FOBT (46% vs 25%, P = 0.002). In particular, among patients with occult OGIB, the prevalence of SBDs was higher in positive FOBT group than negative FOBT group (45% vs 18%, P = 0.002). On the other hand, among patients with previous overt OGIB, there was no significant difference in the prevalence of SBDs between positive and negative FOBT group (47% vs 33%, P = 0.18). In disease specific analysis among patients with occult OGIB, the prevalence of ulcer and tumor were higher in positive FOBT group than negative FOBT group. In multivariate analysis, only positive FOBT was a predictive factors of SBDs in patients with OGIB (OR = 2.5, 95%CI: 1.4-4.6, P = 0.003). Furthermore, the trend was evident among patients with occult OGIB who underwent FOBT on the same day or a day before CE. The prevalence of SBDs in positive vs negative FOBT group were 54% vs 13% in patients with occult OGIB who underwent FOBT on the same day or the day before CE (P = 0.001), while there was no significant difference between positive and negative FOBT group in those who underwent FOBT two or more days before CE (43% vs 25%, P = 0.20). CONCLUSION: The present study suggests that positive FOBT may be useful for predicting SBDs in patients with occult OGIB. Positive FOBT indicates higher likelihood of ulcers or tumors in patients with occult OGIB. Undergoing CE within a day after FOBT achieved a higher diagnostic yield for patients with occult OGIB.

The clinical value of capsule endoscopy in pediatric and adolescent patients for small bowel diseases / 中华消化内镜杂志

Objective To study the clinical value of capsule endoscopy for small bowel diseases in pediatric and adolescent patients.Methods Clinical data of 61 pediatric and adolescent patients who underwent capsule endoscopy from February 2007 to April 2014 was respectively analyzed.The positive diagnostic results and safety were observed.Results Of 61 patients,the CE procedures were completed successfully in 58 patients,and failed in 3 patients because of the gastric stasis.Forty-one positive lesions were found in small intestine,and the detection rate was 70.69％.Positive findings included angiodysplasias,Crohn' s disease,Meckel diverticula,ulcer,P-J syndrome,protrusion lesion and enteritis,etc.Finally,29 patients were confirmed (50％),3 (5.17％) were misdiagnosed and 1 (1.72％) was missed.Twenty-two patients underwent other small bowel examinations besides the capsule endoscopy.And the accuracy of capsule endoscopy was 81.82％.All capsules were successfully swallowed by the patients and evacuated within two weeks.No complications such as capsule retention or intestinal obstruction occurred.Conclusion Capsule endoscopy is a safe and well tolerated procedure with high diagnostic rate,which has a prospective clinical value in small bowel diseases in pediatric and adolescent patients.

Double balloon enteroscopy in the old: experience from China.

AIM: To evaluate the safety, efficacy and management of double balloon enteroscopy (DBE) carried out in those aged individuals with suspicious small intestine diseases. METHODS: DBE is a wonderful invention of the past decade and is widely used as an examination tool for the gastrointestinal tract. From January 2003 to July 2011, data from patients who were ≥ 65 years old and underwent DBE examination in the Nanfang Hospital were included in a retrospective analysis. RESULTS: Fifty-nine individuals were found and subsequently analyzed. The mean age was 69.63 ± 3.89 years (range 65-84), 34 were males. Indications for DBE were melena/hematochezia (36 cases), abdominal pain (15 cases), diarrhea (3 cases), stool change (1 case), weight loss (1 case), vomiting (2 cases), and debilitation (1 case). The average duration of symptoms was 33.34 ± 64.24 mo. Twenty-seven patients suffered from age-related diseases. Severe complications were not found during and after DBE. Comparison between systolic and diastolic blood pressure before and after DBE was statistically significant (mean ± SD, P < 0.01, P < 0.05, respectively). Small bowel pathologies were found by DBE in 35 patients, definite diagnoses were made in 31 cases, and detection rate and diagnostic yield for DBE were 68.6% and 60.8%, respectively. CONCLUSION: DBE is a safe and effective method for gastrointestinal examination in the aged population. Aging alone is not a risk factor for elderly patients with suspicious gastrointestinal diseases and thorough preparation prior to the DBE procedure should be made for individuals with multiple diseases especially cardiopulmonary disorders.

Hemorragia digestiva média e outras indicações de exame com a capsula endoscópica: resultados em uma série consecutiva de 187 pacientes / Avarage gastrointestinal bleeding and other indications of capsule endoscopy examination with the: results in a consecutive series of 187 patients

Objetivo: verificar as indicações e os resultados do emprego da cápsula endoscópica em uma série consecutiva de pacientes, analisando-se, em especial, os casos de hemorragia de causa obscura e também a relação no momento em que o exame foi efetuado em relação à atividade de sangramento. Análises especiais ainda para os casos de exames inconclusivos, cápsulas retidas e lesões fora do delgado. Material e Métodos: 187 pacientes consecutivos submetidos ao exame do intestino delgado pela cápsula foram analisados. Utilizou-se a cápsula da empresa Given, específica para o delgado (versões M2A e PillCam SB), e as análises de imagens foram efetuadas no software específico deste método, versão 5.1. Resultados: 70,5% (132 casos) dos exames foram indicados por hemorragia de causa obscura (64 casos) ou anemia de causa obscura (68 casos). Diarreia, dor abdominal, suspeita de pólipos e outras menos frequentes foram as demais indicações. Dos 187 casos, em 124 deles observaram-se lesões, sendo 101 lesões em delgado e 23 lesões fora do delgado. Em 29,9% dos casos, a cápsula não observou lesões e, em 3,7% do total de casos, o exame foi inconclusivo. Em 5 casos (2,6%), a cápsula ficou retida. As lesões vasculares do intestino delgado representaram o diagnóstico mais frequente e, quando da análise dos casos de hemorragia em relação ao momento do sangramento, demonstrou-se um percentual de 69,5% de encontro de lesões no paciente com sangramento ativo, 77,7% no paciente com sangramento recente e 64,6% no paciente examinado fora do episódio hemorrágico. Conclusões: a hemorragia digestiva ou a anemia, de causa obscura, foi a indicação mais frequente (70,5%) do exame do delgado com a cápsula endoscópica. Na análise dos resultados em 66,3% dos exames efetuados, a cápsula demonstrou lesões, inclusive fora do delgado. As lesões vasculares foram as mais encontradas e, nos casos de hemorragia/anemia de causa obscura, a capacidade da cápsula em encontrar lesões foi maior nos pacientes que efetuaram o exame durante o episódio hemorrágico, ou logo após do mesmo, do que em pacientes nos quais o exame foi feito distante deste episódio, embora estes resultados não tivessem relevância estatística. Exames inconclusivos tiveram um percentual de 3,7% dos casos e, em 2,6% dos casos, a cápsula ficou retida em estenoses do delgado.

Objectives: to verify the indications and results of the use of endoscopy capsule in a consecutive series of patients, especially the cases of obscure bleeding cause with the moment when the examination was made (related to bleeding activity). Special analysis for the cases not conclusive yet, retained capsules and lesions out of small bowel. Materials and Methods: 187 consecutive patients underwent the small bowel examination by the capsule were analyzed. A capsule from the Given company was used, it is specific for small bowel (M2A e PillCam SB) and the analyses were made in this brand-specific software, version 5,1. Results: in the analysis it was observed that 70,5% of them (132 cases) were indicated by obscure bleeding cause (64 cases) or obscure anemia cause (68 cases). Diarrhea, abdominal pain, suspected polyps and others least often were the other indications. From the 187 cases, in 124 of them were observed lesions, 101 of them in the small bowel and 23 lesions out of it. In 29,9% of the cases the capsule did not observed lesions and in 3,7% of all cases the examination was inconclusive. In 5 cases (2,6%) the capsule was retained. Vascular lesions of the small bowel were the most frequent diagnosis, and the bleeding causes analysis, in relation to the bleeding moment, 69,5% of lesions in the patient with the active bleeding were showed, 77,7% in the patient with recent bleeding and 64,6% in the patient whose examination was out of the bleeding episode. Conclusion: gastrointestinal bleeding and/or obscure anemia cause were the most frequent indication (70,5%) of the small bowel examination with the endoscopy capsule. In the results analysis, in 66,3% of the examinations made, the capsule showed lesion(s), even out of the small bowel. Vascular lesions were the most found and in the obscure bleeding/anemia cause cases the capsules capacity to find lesions was higher in patients that did the examination during the bleeding episode or just after it, than in patients that the examination was done far from the episode. Inconclusive examinations had a percentage of 3,7 of cases and in 2,6% of cases the capsule was retained in small bowel stenosis.

CT enteroclysis in the diagnostics of small bowel diseases.

BACKGROUND: The role of CT enteroclysis is gaining on importance in the diagnostics of small bowel diseases. The aim of the study was to present own experiences in CT enteroclysis application, with the use of a 64-detector CT unit. MATERIAL/METHODS: CT enteroclyses were performed in 60 patients: 53 with the suspicion of the Crohn's disease, 2 suspected for carcinoid, 1 with suspicion of the fistula between the small bowel and the bladder, 2 suspected for the tumor of the ileo-caecal region, and in 1 case, the aim of examination was to carry out an evaluation of the postsurgical state of the bowel-bowel anastomosis. We used own endoscopic technique of catheter insertion into the bowel, which shortens the examination time and improves patient's comfort. RESULTS: The catheter was correctly introduced into the small bowel in 58 patients (endoscopy had to be repeated in 4 cases). Only 2 examinations failed, because patients refused repeated endoscopy. Radiological signs of the Crohn's disease were found in 50 out of 53 patients. In the 3 remaining patients, the appearance of the small bowel was normal. In 5 non-Crohn's disease patients, CT enteroclysis enabled a good visualization of the pathology (tumors, fistula). CONCLUSIONS: CT enteroclysis with the use of the 64-detector CT unit is a valuable method in the diagnostics of small bowel diseases. It could supplement or precede capsule endoscopy.

Single balloon enteroscopy for diagnosis of small bowel diseases / 中华消化内镜杂志

Objective To evaluate the safety, indications and clinical efficacy of single balloon enteroscopy (SBE) for diagnosis of small bowel diseases. Methods Data of 30 patients (21 males and 9 females) with suspected small bowel diseases, who underwent SBE from June to September 2009, were retrospectively studied to analyze the access, procedure time and complications of SBE. Results A total of 35 SBE procedures were performed on 30 patients. Procedures were performed via oral, anal and the combined routes in 15, 10 and 5 cases, respectively, and definite diagnosis was made in26 cases (86. 7% ). The average access times via oral and anal routes were 49.7 min and 48. 6 min, respectively. Patietns showed normal vital signs during the procedures. No such procedure-related complications as cadiovascular events, severe abdominal pain, bleeding or perforation, were observed. Conclusion SBE is a safe and reliable diagnostic modality of high clinical value for small bowel diseases.

Enteroscopia de doble balón en niños: Aplicabilidad del método, posibilidades diagnósticas y terapéuticas en enfermedades del intestino delgado

Objetivo: las enfermedades del intestino delgado son de difícil diagnóstico en pediatría. La enteroscopia doble balón permite visualizar el intestino delgado completo y realizar terapéutica. Los reportes publicados se refieren a adultos y poco se conoce de su utilidad en niños. Reportamos la primera experiencia en Venezuela utilizando enteroscopia doble balón en niños, para evaluar aplicabilidad, seguridad y eficacia del método en el diagnóstico y tratamiento de enfermedades del intestino delgado en pediatría. Pacientes y métodos: 9 pacientes, entre 8 y 15 años, utilizando un enteroscopio Fujinon, con una longitud de trabajo de 200 cm y un sobretubo de 145 cm de longitud. Indicaciones: hemorragia digestiva oscura, diarrea crónica y evaluación de síndromes de poliposis. Resultados: 9 procedimientos. La mayor duración fue 60 minutos. Hallazgos: angiodisplasias, divertículo de Meckel, malformaciones vasculares, várices intestinales, enteropatía celíaca, enteropatía alérgica, pólipos. Se modifico la conducta en 9/9 (100%) se realizó terapéutica endoscópica en el procedimiento en 7/9 (77,7%). No hubo complicaciones. Conclusiones: la enteroscopia doble balón es un nuevo método aplicable, útil y seguro para la evaluación del intestino delgado en niños que permite, en un alto porcentaje, modificar la terapéutica y realizar tratamiento específico en el acto, lo cual implica un alto rendimiento del método.

Small bowel diseases are difficult to diagnose in children. With double-balloon enteroscopy is possible to see the entire small bowel and perform therapeutic procedures. Literature reports the use of this procedure in adult population and little is known their utility in children. We present here the first study in Venezuelan children using the double-balloon enteroscopy, to evaluate feasibility, safety, and clinical efficacy of double-balloon enteroscopy in diagnosis and treatment of small bowel disease in children. Patient and methods: 9 procedures in 9 patients, between ages 8 to 15 years, All patients underwent double-balloon enteroscopy using a Fujinon enteroscope length 200 cm, and overtube length of 145 cm. Indications: Obscure gastrointestinal bleeding, chronic diarrhea and evaluation of polyposis syndrome. Results: 9 procedures. Largest duration of procedures was 60 minutes. Findings: angiodysplasia, Meckel diverticulum, vascular malformations, variceal veins, celiac enteropathy, allergic enteropathy, polyps. We changed the usual treatment in 9/9 (100%) and performed endoscopic procedure in 7/9 (77,7%). No patient experienced complications. Conclusion: Double-balloon enteroscopy is a novel, useful, reliable and safe procedure for evaluation of small bowel in children which allows changing therapeutics and performing endoscopic treatment at the same time, with high performance of the method.

Application of double-balloon push enteroscopy in diagnosis of small bowel diseases / 中华消化杂志

Objective To evaluate safety, extensity and clinical efficacy and patient tolerance of double-balloon push enteroscopy in diagnosis of patients with small bowel diseases. Methods Thirty cases suspected of small bowel diseases with negative findings of various routine diagnostic modalities were performed double-balloon push enteroscopy from April to July, 2003. Among which 20 cases were patients with gastrointestinal bleeding of unknown origin, and numbers of patient with abdominal pain, chronic diarrhea and partial small intestine obstruction of unknown causes were 5, 3 and 2 cases, respectively. Results The enteroscopy reached to jejunal-ileum transitional area, middle or low portion of ileum and terminal ileum in 9, 17 and 4 cases, with mean examination time ( 40.5 ?12.3) min , ( 64.3 ?18.6) min and ( 78.8 ?11.5) min , respectively. Most of patients were fairly tolerated to the procedure. The lesion was detected in 25 of 30 cases, the total diagnostic yield was 83.3% , and positive diagnostic rates in obscure gastrointestinal bleeding, abdominal pain, chronic diarrhea and partial small bowel obstruction were 80.0% , 80.0% , 33.3% and 100.0% respectively. No procedure-related complications were observed in all cases. Conclusion Double-balloon push enteroscopy was a safe, reliable diagnostic modality of high clinical value for small bowel diseases.

Analysis of 115 clinical suspected small intestinal diseases detected by double balloon enteroscopy / 中国实用内科杂志

Objective To analyze the clinical features of patients with negative double balloon enteroscopy(DBE)findings.Methods A total of 115 patients with suspected small intestinal diseases underwent DBE examination from gastroenterology department of Wuhan University People's hospital on December 2005 to July 2009.The negative and positive cases were 32 and 83 respectively,then compared clinical data of negative group with that of positive group.Results 83 cases with small intestinal diseases were detected from 115 patients by DBE examination,and the daignosis rate was 72.2%(83/115).2 patients occurred acute pancreatitis and 1 occurred hyperamylasemia.The level of initial hemoglobin of negative group was higher than that of positive group(107.938?26.015 vs 93.518?32.367,P=0.016).meanwhile,there were significant difference in clinical symptoms(unexplained alimentary tract hemorrhage,obscure partial bowel obstruction,abdominal pain and diarrhea)between two groups(P=0.035).Moreover,the positive detection rate of unexplained alimentary tract hemorrhage(81.8%)was obviously higher than that of abdominal pain(57.7%)or diarrhea(40%).Conclusion DBE examination is an effective method in the diagnosis of small bowel diseases at present,however,patients with higher level of initial hemoglobin or the main symptoms as abdominal pain or diarrhea should be prudent to choose.