Original articles
Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases

Presented in part at the annual meeting of the American Society for Gastrointestinal Endoscopy, May, 2004.
https://doi.org/10.1016/S1542-3565(04)00453-7Get rights and content

Background & Aims: A specialized system for a new method for enteroscopy, the double-balloon method, was developed. The aim of this study was to evaluate the usefulness of this endoscopic system for small-intestinal disorders. Methods: The double-balloon endoscopy system was used to perform 178 enteroscopies (89 by the anterograde approach and 89 by the retrograde approach) in 123 patients. The system was assessed on the basis of the rates of success in jejunal and ileal insertion and the entire examination of the small intestine, diagnostic yields, ability to perform treatment, and complications. Results: Insertion of the endoscope beyond the ligament of Treitz or ileocecal valve was possible in all 178 procedures. It was possible to observe approximately one half to two thirds of the entire small intestine by each approach, and observation of the entire small intestine was possible in 24 (86%) of 28 trials. The source of bleeding was identified in 50 (76%) of 66 patients with GI bleeding, scrutiny of strictures was possible in 23 patients, and a tumor was examined endoscopically in 17 patients. Two complications (1.1%) occurred. Endoscopic therapies in the small intestine including hemostasis (12 cases), polypectomy (1 case), endoscopic mucosal resection (1 case), balloon dilation (6 cases), and stent placement (2 cases) were performed successfully. Conclusions: Double-balloon endoscopy permits the exploration of the small intestine with a high success rate of total enteroscopy. The procedure is safe and useful, and it provides high diagnostic yields and therapeutic capabilities.

Section snippets

Patients and methods

Between September 2000 and March 2004, 178 enteroscopies, including 89 anterograde and 89 retrograde procedures, were performed on 123 patients in Jichi Medical School Hospital, Japan, using the Fujinon double-balloon endoscopy system (Fuji Photo Optical Co., Ltd., Saitama, Japan). In some patients, more than 1 enteroscopy was performed for endoscopic treatment of small-intestinal lesions or endoscopic assessment after the treatment. Double-balloon endoscopy was approved by the ethics committee

Success rates of inserting the double-balloon endoscope in the small intestine

The rates of successful insertion of the double-balloon endoscope into the small intestine by the anterograde approach and the retrograde approach were assessed separately. Insertion beyond the ligament of Treitz and endoscopic observation of the jejunum was achieved by the double-balloon method in all 89 anterograde insertion procedures, and the maximum depth of insertion was beyond the ileocecal valve into the ascending colon in 2 cases. The average depth of insertion estimated from the

Discussion

The need for endoscopic examination of the small intestine has been well established, and the advent of capsule endoscopy is undoubtedly a significant breakthrough for visual diagnosis of the small intestine because it enables easy access to the entire small intestine.9, 10 In addition, we have established a new method of enteroscopy, the double-balloon method, that also allows direct access to the entire small intestine; the clinical value of this new method was evaluated in this study. The

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