Total enteroscopy with a nonsurgical steerable double-balloon method

doi:10.1067/mge.2001.112181

Gastrointestinal Endoscopy

Volume 53, Issue 2, February 2001, Pages 216-220

Presented in part at the annual meeting of the American Society for Gastrointestinal Endoscopy, May 2000, San Diego, California.

https://doi.org/10.1067/mge.2001.112181 Get rights and content

Abstract

Background: Deep insertion of an enteroscope by use of a push technique is difficult. A new method of enteroscopy was developed, a double-balloon method, to improve the access to the small intestine. Methods: The new method uses 2 balloons, one attached to the tip of the endoscope and another at the distal end of an overtube. By using these balloons to grip the intestinal wall, the endoscope can be inserted further without forming redundant loops in the small intestine. This method was tried with a standard upper endoscope in 3 patients and with a longer enteroscope in 1 patient. Results: Despite its short length the upper endoscope was successfully inserted as far as 30 to 50 cm beyond the ligament of Treitz in the 3 patients. In the fourth patient the longer enteroscope was successfully inserted beyond the ileo-cecal valve. Conclusions: The double-balloon method facilitates endoscopic access to the small intestine.

Section snippets

Patients and methods

Between June 29 and December 3 of 1999 the new method of enteroscopy was attempted in 4 patients. Full and informed consent was obtained from each patient before the procedure.

Results

Four patients underwent the double-balloon method of enteroscopy (Table 1).

. Characteristics of patients and procedures

Patient	Age (y)	Gender	Indication	Sedation	Scope	Depth of insertion	Findings	Complications
1	41	M	GI bleeding	None	XP-240	30 cm beyond LT	Bleeding hemangioma	None
2	14	F	GI bleeding	Diazepam 7.5 mg i.v.	XP-240	30 cm beyond LT	Bleeding hemangioma
3	78	F	Protein losing enteropathy	Diazepam 5 mg i.v.	XP-240	40 cm beyond LT	Benign stricture	None
4	69	F	GI bleeding	Diazepam 15 mg i.v.	SIF-Q240	Up to cecum	Meckel's diverticulum

Discussion

The value of endoscopic exploration of the small bowel has been well documented. Established indications for small-bowel enteroscopy include unexplained digestive bleeding, radiographic abnormalities of the small intestine, and chronic diarrhea or malabsorption.1, 2, 10

At present, the most effective procedure for complete visualization of the small intestine is intraoperative enteroscopy. Fiberoptic endoscopes were used intraoperatively in the 1970s.⁴ No major advancements regarding insertion

References (13)

JD Waye
Enteroscopy
Gastrointest Endosc
(1997)
BS Lewis et al.
Total small bowel enteroscopy
Gastrointest Endosc
(1987)
A Zaman et al.
Total peroral intraoperative enteroscopy for obscure GI bleeding using a dedicated push enteroscope: diagnostic yield and patient outcome
Gastrointest Endosc
(1999)
M Ingrosso et al.
Laparoscopically assisted total enteroscopy: a new approach to small intestinal diseases
Gastrointest Endosc
(1999)
B Landi et al.
Diagnostic yield of push-type enteroscopy in relation to indication
Gut
(1998)
H Hiratsuka et al.
Endoscopic diagnosis of the small intestine
Stomach Intestine
(1972)

There are more references available in the full text version of this article.

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^☆: Reprint requests: Hironori Yamamoto, MD, Department of Gastroenterology, Jichi Medical School, Yakushiji, Minamikawachi, Tochigi, Japan 329-0498.

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New Methods & MaterialsTotal enteroscopy with a nonsurgical steerable double-balloon method☆

Abstract

Section snippets

Patients and methods

Results

Discussion

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Diagnostic yield of push-type enteroscopy in relation to indication

Gut

Endoscopic diagnosis of the small intestine

Stomach Intestine

New Methods & Materials
Total enteroscopy with a nonsurgical steerable double-balloon method☆