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double balloon enteroscopy in children:Diagnosis,treatment,and safety

World Journal of Gastroenterology 2010年第1期16卷 56-62页

作者： Mike Thomson Krishnappa Venkatesh Khalid Elmalik Willam van der Veer Maartan Jaacobs Centre for Paediatric Gastroenterology Sheffield Children's NHS Foundation Trust Department of Gastroenterology VU University Medical Center

AIM:To assess the feasibility and utility of double balloon enteroscopy(DBE)in the management of small bowel diseases in children. METHODS:Fourteen patients(10 males)with a median age of 12.9 years(range 8.1-16.7)underwent DBE; 5 for Peutz-Jeghers syndrome(PJ syndrome),2 for chronic abdominal pain,4 for obscure gastrointestinal (GI)bleeding,2 with angiomatous malformations(1 blue rubber bleb nevus syndrome)having persistent GI bleeding,and 1 with Cowden's syndrome with multiple polyps and previous *** procedures were performed under general anesthesia and 3 with deep sedation. RESULTS:The entire small bowel was examined in 6 patients,and a length between 200 cm and 320 cm distal to pylorus in the remaining *** patients had both antegrade(trans-oral)and retrograde(transanal and via ileostomy)*** patient underwent DBE with planned laparoscopic *** remaining 6 had trans-oral examination *** median examination time was 118 min(range 95-195). No complications were *** were detected and successfully removed in all 5 patients with PJ syndrome,in a patient with tubulo-villous adenoma of the duodenum,in a patient with significant anemia and occult bleeding,and in a patient with Cowden's syndrome.A diagnosis was made in a patient with multiple angiomata not amenable to endotherapy,and in 1 with a discrete angioma which was treated with argon plasma *** source of bleeding was identified in a further patient with *** was normal or revealed minor mucosal friability in the remaining 3 *** a diagnostic yield of 11/14 with therapeutic success in 9/14 was achieved. CONCLUSION:double balloon enteroscopy can be a useful diagnostic and therapeutic tool for small bowel disease in children,allowing endo-therapeutic intervention beyond the reach of the conventional endoscope.

关键词： double balloon enteroscopy Gastrointestinal Peutz Jeghers syndrome Wireless video capsule endoscopy Children

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double balloon enteroscopy in the old: Experience from China

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World Journal of Gastroenterology 2012年第22期18卷 2859-2866页

作者： Qiong He Qiang Zhang Jian-Dong Li Ya-Dong Wang Tian-Mo Wan Zhen-Yu Chen De-Shou Pan Jian-Qun Cai Si-De Liu Bing Xiao Ya-Li Zhang Bo Jiang Yang Bai Fa-Chao Zhi Guangdong Provincial Key Labora-tory of Gastroenterology Nanfang Hospital Southern MedicalUniversity Guangzhou 510515 Guangdong Province China Department of Epidemiology School of Public Health and Tropical Medicine Southern Medical University Guangzhou 510515 Guangdong Province China Department of Gastroenterology Nanfang Hospital Southern Medical University Guangzhou 510515 Guangdong Province 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 ***: 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.

关键词： double balloon enteroscopy Capsule endos-copy Small bowel diseases Multiple systematic diseases

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double balloon enteroscopy examinations in general anesthesia

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World Journal of Gastroenterology 2010年第27期16卷 3418-3422页

作者： Laszlo Zubek Lena Szabo Peter Laszlo Lakatos Janos Papp Janos Gal Gabor Elo Department of Anaesthesiology and Intensive Therapy Semmelweis University 2nd Department of Pediatrics Semmelweis University 1st Department of Medicine Semmelweis University

AIM:To demonstrate that the double balloon enteroscopy(DBE) can be safely performed in general anesthesia with ***:We performed a retrospective examination between August 2005 and November 2008 amongpatients receiving intubation narcosis due to DBE *** patients were grouped based on sex,age and physical *** records includedduration of anesthesia,quantity of medication usedand anesthesia-related *** determinedthe frequency of complications in the different groupsand their relation with the quantity of medication usedand the duration of ***:We compiled data for 108 cases of general anesthesia with *** did not observeany permanent anesthesia-related complications;themost frequent side effects of anesthesia were hypo-tension(30.55%),desaturation(21.29%),and apnea(17.59%).These complications were significantly more frequent among patients with multiple additional diseases [hypotension(23.1% vs 76.9%,P = 0.005),desaturation(12.3% vs 69.2%,P < 0.001) and apnea(7.7% vs 53.8%,P = 0.001)],however,their incidence was not proportional to the quantity of medication used or the duration of ***:General anesthesia with intubation is definitely a viable option among DBE *** is highly recommended in patients with multiple additional diseases.

关键词： double balloon enteroscopy General anesthesia Intubation Sedation Patient autonomy

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Evaluation of “top-down” treatment of early Crohn's disease by double balloon enteroscopy

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World Journal of Gastroenterology 2014年第39期20卷 14479-14487页

作者： Rong Fan Jie Zhong Zheng-Ting Wang Shu-Yi Li Jie Zhou Yong-Hua Tang Department of Gastroenterology Ruijin Hospital Shanghai Jiao Tong University School of Medicine Department of Radiology Ruijin Hospital Shanghai Jiao Tong University School of Medicine

AIM: To assess “top-down” treatment for deep remission of early moderate to severe Crohn’s disease (CD) by double balloon enteroscopy.

关键词： Crohn’ s disease Top-down treatment Deep remission double balloon enteroscopy Mucosal healing

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Evidences supporting the vascular etiology of post-double balloon enteroscopy pancreatitis: Study in porcine model

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World Journal of Gastroenterology 2017年第34期23卷 6201-6211页

作者： Rafael Latorre Octavio López-Albors Federico Soria Esther Morcillo Pilar Esteban Enrique Pérez-Cuadrado-Robles Enrique Pérez-Cuadrado-Martínez Department of Anatomy and Comparative Pathology University of Murcia Minimally Invasive Surgery Centre Jesús Usón Department of Gastroenterology Small Bowel UnitMorales Meseguer Hospital

double balloon enteroscopy(DBE) is an endoscopic technique broadly used to diagnose and treat small bowel diseases. Among the associated complications of the oral DBE, post-procedure pancreatitis has taken the most attention due to its gravity and the thought that it might be associated to the technique itself and anatomical features of the pancreas. However, as the etiology has not been clarified yet, this paper aims to review the published literature and adds new results from a porcine animal model. Biochemical markers, histological sections and the vascular perfusion of the pancreas were monitored in the pig during DBE practice. A reduced perfusion of the pancreas and bowel, the presence of defined hypoxic areas and disseminated necrotic zones were found in the pancreatic tissue of pigs. All these evidences contribute to support a vascular distress as the most likely etiology of the post-DBE pancreatitis.

关键词： double balloon enteroscopy Pancreas Animal model Pancreatitis Pig

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A meta-analysis of the yield of capsule endoscopy compared to double-balloon enteroscopy in patients with small bowel diseases

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World Journal of Gastroenterology 2007年第32期13卷 4372-4378页

作者： Xiang Chen Zhi-Hua Ran Jin-Lu Tong Department of gastroenterology Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai Institute of Digestive Disease Shanghai 200001 China

AIM:To compare the diagnostic yield of capsule endoscopy (CE) with that of double-balloon enteroscopy (DBE). METHODS:Pubmed,Embase,Elsevier ScienceDirect,the China Academic Journals Full-text Database,and Cochrane Controlled Trials Register were searched for the trials comparing the yield of CE with that of DBE. Outcome measure was odds ratio (OR) of the yield. Fixed or random model method was used for data analysis. RESULTS:Eight studies (n = 277) which prospectively compared the yield of CE and DBE were collected. The results of meta-analysis indicated that there was no difference between the yield of CE and DBE 170/277 vs 156/277,OR 1.21 (95% CI:0.64-2.29). Based on sub analysis,the yield of CE was significantly higher than that of double-balloon enteroscopy without combination of oral and anal insertion approaches 137/219 vs 110/219,OR 1.67 (95% CI:1.14-2.44),P 0.05). A focused meta-analysis of the fully published articles concerning obscure GI bleeding was also performed and showed similar results wherein the yield of CE was significantly higher than that of DBE without combination of oral and anal insertion approaches 118/191 vs 96/191,fixed model:OR 1.61 (95% CI:1.07-2.43),P < 0.05) and the yield of CE was significantly lower than that of DBE by oral and anal combinatory approaches 11/24 vs 21/24,fixed model:OR 0.12 (95% CI:0.03-0.52),P < 0.01). CONCLUSION:With combination of oral and anal approaches,the yield of DBE might be at least as high asthat of CE. Decisions made regarding the initial approach should depend on patient's physical status,technology availability,patient's preferences,and potential for therapeutic endoscopy.

关键词： Capsule endoscopy double balloon enteroscopy Yield Meta-analysis

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double-balloon-enteroscopy-based endoscopic retrograde cholangiopancreatography in post-surgical patients

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World Journal of Gastroenterology 2011年第18期17卷 2302-2314页

作者： Martin Raithel Harald Dormann Andreas Naegel Frank Boxberger Eckhart G Hahn Markus F Neurath Juergen Maiss Department of Medicine 1 University of Erlangen-Nürnberg Emergency Unit City Hospital Fürth Dean of the University Witten-Herdecke

AIM: To evaluate double balloon enteroscopy (DBE) in post-surgical patients to perform endoscopic retrograde cholangiopancreatography (ERCP) and interventions. METHODS: In 37 post-surgical patients, a stepwise approach was performed to reach normal papilla or enteral anastomoses of the biliary tract/pancreas. When conventional endoscopy failed, DBE-based ERCP was performed and standard parameters for DBE, ERCP and interventions were recorded. RESULTS: Push-enteroscopy (overall, 16 procedures) reached enteral anastomoses only in six out of 37 post-surgical patients (16.2%). DBE achieved a high rate of luminal access to the biliary tract in 23 of the remaining 31 patients (74.1%) and to the pancreatic duct (three patients). Among all DBE-based ERCPs (86 procedures), 21/23 patients (91.3%) were successfully treated. Interventions included ostium incision or papillotomy in 6/23 (26%) and 7/23 patients (30.4%), respectively. Biliary endoprosthesis insertion and regular exchange was achieved in 17/23 (73.9%) and 7/23 patients (30.4%), respectively. Furthermore, bile duct stone extraction as well as ostium and papillary dilation were performed in 5/23 (21.7%) and 3/23 patients (13.0%), respectively. Complications during DBE-based procedures were bleeding (1.1%), perforation (2.3%) and pancreatitis (2.3%), and minor complications occurred in up to 19.1%. CONCLUSION: The appropriate use of DBE yields a high rate of luminal access to papilla or enteral anastomoses in more than two-thirds of post-surgical patients, allowing important successful endoscopic therapeutic interventions.

关键词： double balloon enteroscopy Endoscopic retrograde cholangiopancreatography Choledochojejunostomy Hepaticojejunostomy Pancreaticojejunostomy Percutaneous cholangiodrainage

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Role of balloon enteroscopy for obscure gastrointestinal bleeding in those with surgically altered anatomy: A systematic review

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World Journal of Gastrointestinal Endoscopy 2022年第7期14卷 434-442页

作者： Mahmoud Aryan Tyler Colvin Ali M Ahmed Kondal Rao Kyanam Kabir Baig Shajan Peter Department of Internal Medicine University of Alabama at BirminghamBirminghamAL 35294United States Department of Gastroenterology and Hepatology University of Alabama at BirminghamBirminghamAL 35294United States

BACKGROUND Obscure gastrointestinal(GI)bleeding is defined as persistent bleeding despite negative evaluation with both esophagogastroduodenoscopy and colonoscopy and can be secondary to small intestinal *** endoscopy as well as push endoscopy can be a challenge in those with altered anatomy given inaccessible areas as well as perforation *** and double balloon enteroscopy can be warranted in this patient population in instances of obscure GI *** To assess the safety and diagnostic efficacy of balloon enteroscopy for obscure GI bleeding in patients with surgically altered *** A search was conducted through PubMed,MEDLINE,Google Scholar,Scopus,and Embase with the key words“enteroscopy,”“obscure bleeding,”and“altered anatomy,”to identify relevant articles in English with no restricted time frame.A search within the Reference Citation Analysis database was conducted to ensure inclusion of the latest high impact *** types included in the review were prospective and retrospective reviews,case series,and case *** reference lists of these papers were also reviewed to find further papers that were *** authors extracted the data from the studies that fit inclusion *** of interest included type of study,type of procedure,and type of altered anatomy,as well as the number of patients with any diagnostic or therapeutic *** was also recorded on procedure tolerance and *** data was analyzed with descriptive *** Our literature search yielded 14 studies that were *** were 68 procedures performed with 61 unique patients subjected to these ***-four(65%)of the procedures were double balloon,21(31%)were single balloon,and 3(4%)were classified as through the scope balloon *** most common altered anatomy types included Gastric Bypass Roux-en-Y,Pylorus Sparing Whipple,Orthotopic Liver Transplantation with Roux-en-Y,and Gastrojejunostom

关键词： Altered anatomy Single balloon enteroscopy double balloon enteroscopy Obscure Bleed Gastrointestinal

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Two case reports of acute upper gastrointestinal bleeding from duodenal ulcers after Roux-en-Y gastric bypass surgery: Endoscopic diagnosis and therapy by single balloon or push enteroscopy after missed diagnosis by standard esophagogastroduodenoscopy

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World Journal of Gastrointestinal Endoscopy 2017年第10期9卷 521-528页

作者： Seifeldin Hakim Srinivas R Rami Reddy Mihaela Batke Gregg Polidori Mitchell S Cappell Division of Gastroenterology and Hepatology Department of MedicineWilliam Beaumont Hospital Oakland University William Beaumont School of Medicine

The diagnosis and opportunity for endoscopic therapy of gastric or duodenal lesions may be missed at esophagogastroduodenoscopy(EGD) because of technical difficulty in intubating at EGD the postoperatively excluded stomach and proximal duodenum in patients status post Roux-en-Y gastric bypass(RYGB). Two cases are reported of acute upper gastrointestinal bleeding 10 or 11 years status postRYGB, performed for morbid obesity, in which the EGD was non-diagnostic due to failure to intubate the excluded stomach and proximal duodenum, whereas subsequent push enteroscopy or single balloon enteroscopy were diagnostic and revealed 4-cm-wide or 5-mm-wide bulbar ulcers and even permitted application of endoscopic therapy. These case reports suggest consideration of push enteroscopy, or single balloon enteroscopy, where available, in the endoscopic evaluation of acute UGI bleeding in patients status post RYGB surgery when the EGD was non-diagnostic because of failure to intubate these excluded segments.

关键词： Morbid obesity Bariatric surgery Roux-en-Y gastric bypass surgery Upper gastrointestinal bleeding Esophagogastroduodenoscopy Push enteroscopy Single balloon enteroscopy Therapeutic endoscopy double balloon enteroscopy

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Treatment of gastrointestinal bleeding in left ventricular assist devices:A comprehensive review

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World Journal of Gastroenterology 2020年第20期26卷 2550-2558页

作者： Srikanth Vedachalam Gokulakrishnan Balasubramanian Garrie J Haas Somashekar G Krishna Department of Internal Medicine The Ohio State University Wexner Medical CenterColumbusOH 43210United States Division of Gastroenterology Hepatology and NutritionThe Ohio State University Wexner Medical CenterColumbusOH 43210United States Division of Cardiovascular Medicine The Ohio State University Wexner Medical CenterColumbusOH 43210United States

Left ventricular assist devices(LVAD)are increasingly become common as life prolonging therapy in patients with advanced heart *** devices are now used as definitive treatment in some patients given the improved durability of continuous flow ***,continuous flow LVADs are fraught with complications such as gastrointestinal(GI)bleeding that are primarily attributed to the formation of arteriovenous *** frequent GI bleeding,antiplatelet and anticoagulation therapies are usually discontinued increasing the risk of life-threatening *** bowel bleeds account for 15%as the source and patients often undergo multiple endoscopic *** strategies include resuscitative measures and endoscopic *** treatment is with *** treatment options include thalidomide,angiotensin converting enzyme inhibitors/angiotensinⅡreceptor blockers,estrogen-based hormonal therapies,doxycycline,desmopressin and *** research has explored the mechanism of frequent GI bleeds in this population,including destruction of von Willebrand factor,upregulation of tissue factor,vascular endothelial growth factor,tumor necrosis factor-α,tumor growth factor-β,and angiopoetin-2,and downregulation of *** addition,healthcare resource utilization is only increasing in this patient population with higher admissions,readmissions,blood product utilization,and *** some of the novel endoscopic and medical therapies for LVAD bleeds are still in their development stages,these tools will yet be crucial as the number of LVAD placements will likely only increase in the coming years.

关键词： Left ventricular assist device Push enteroscopy double balloon enteroscopy Video capsule endoscopy Octreotide Bevacizumab Gastrointestinal bleeding

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