Single-operator single-balloon enteroscopy is safe and effective: A 6-year retrospective study

Abstract

Objectives: Single-balloon enteroscopy (SBE) is an effective tool for the detection of small intestine lesions. Because it is conventionally performed by two operators, the efficacy of single-operator SBE method has not yet been elucidated. We aimed to evaluate the diagnostic yield, total enteroscopy rate, procedure time, and complications of single-operator SBE for small intestinal disease.

Methods: This was a single-center, retrospective study including consecutive patients who underwent single-operator SBE for suspicious small intestinal disorders or required therapeutic interventions between December 2014 and January 2019. The SBE procedures were performed by four endoscopists. Diagnostic yield, total enteroscopy rate, procedure time, incubation depth, and complications were analyzed, and stratification analysis was performed.

Results: Altogether 922 patients with 1422 SBE procedures were included for analysis, among whom 250, 172, and 500 patients underwent SBE via the oral route, the anal route and a combined route, respectively. The overall diagnostic yield was 78.52% (724/922). And 253 patients achieved total enteroscopy, with a total enteroscopy rate of 56.10%. The average procedure time for the oral and anal routes were 69.28 ± 14.72 min and 64.95 ± 13.87 min, respectively. While the incubation depth was 389.95 ± 131.42 cm and 191.81 ± 83.67 cm, respectively. Jejunal perforation was observed in one patient, which was managed by endoclips. Stratification analysis showed that the diagnostic yield and total enteroscopy rate significantly increased with operation experience together with decreased procedure time.

Conclusion: Single-operator SBE is effective and safe for the detection of small intestinal lesions, and is easy to master.

Keywords

single-balloon enteroscopy / single operator / small bowel disease

References

[1] Triester SL,Leighton JA,Leontiadis GI, et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding. Am J Gastroenterol. 2005; 100(11):2407-2418.

[2] Yamamoto H,Sekine Y,Sato Y, et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc. 2001; 53(2):216-220.

[3] Yamamoto H,Yano T,Kita H,Sunada K,Ido K,Sugano K. New system of double-balloon enteroscopy for diagnosis and treatment of small intestinal disorders. Gastroenterology. 2003; 125(5):1556.

[4] Yamamoto H,Sugano K. A new method of enteroscopy – the double-balloon method. Can J Gastroenterol. 2003; 17(4):273-274.

[5] Kawamura T,Yasuda K,Tanaka K, et al. Clinical evaluation of a newly developed single-balloon enteroscope. Gastrointest Endosc. 2008; 68(6):1112-1116.

[6] Tsujikawa T,Saitoh Y,Andoh A, et al. Novel single-balloon enteroscopy for diagnosis and treatment of the small intestine: preliminary experiences. Endoscopy. 2008; 40(1):11-15.

[7] Hartmann D,Eickhoff A,Tamm R,Riemann JF. Balloon-assisted enteroscopy using a single-balloon technique. Endoscopy. 2007; 39(Suppl 1): E276.

[8] Lee SH,Park YK,Lee DJ,Kim KM. Colonoscopy procedural skills and training for new beginners. World J Gastroenterol. 2014; 20(45):16984-16995.

[9] Lee IL,Wu CS. Less patient discomfort by one-man colonoscopy examination. Int J Clin Pract. 2006; 60(6):635-638.

[10] Chen HS,Wu JF,Chen HL,Ni YH. Does one-man method better than two-man method for colonoscopy insertion in children. J Formos Med Assoc. 2019; 118(11):1546-1550.

[11] Gross SA,Stark ME. Initial experience with double-balloon enteroscopy at a U.S. center. Gastrointest Endosc. 2008; 67(6):890-897.

[12] Di Nardo G,Oliva S,Aloi M, et al. Usefulness of single-balloon enteroscopy in pediatric Crohn’s disease. Gastrointest Endosc. 2012; 75(1):80-86.

[13] Li X,Zhao YJ,Dai J, et al. Carbon dioxide insufflation improves the intubation depth and total enteroscopy rate in single-balloon enteroscopy: a randomised, controlled, double-blind trial. Gut. 2014; 63(10):1560-1565.

[14] Lenz P,Meister T,Manno M, et al. CO₂ insufflation during single-balloon enteroscopy: a multicenter randomized controlled trial. Endoscopy. 2014; 46(1):53-58.

[15] Schlag C,Neu B,Klare P,Wagenpfeil S,Schmid RM,von Delius S. Magnetic endoscope imaging in single-balloon enteroscopy. Dig Endosc. 2015; 27(4):465-470.

[16] Li X,Chen H,Dai J,Gao Y,Ge Z. Predictive role of capsule endoscopy on the insertion route of double-balloon enteroscopy. Endoscopy. 2009; 41(9):762-766.

[17] May A,Nachbar L,Ell C. Double-balloon enteroscopy (push-and-pull enteroscopy) of the small bowel: feasibility and diagnostic and therapeutic yield in patients with suspected small bowel disease. Gastrointest Endosc. 2005; 62(1):62-70.

[18] Domagk D,Mensink P,Aktas H, et al. Single-vs. double-balloon enteroscopy in small-bowel diagnostics: a randomized multicenter trial. Endoscopy. 2011; 43(6):472-476.

[19] Mehdizadeh S,Ross A,Gerson L, et al. What is the learning curve associated with double-balloon enteroscopy? Technical details and early experience in 6 U.S. tertiary care centers. Gastrointest Endosc. 2006; 64(5):740-750.

[20] Efthymiou M,Desmond PV,Brown G, et al. SINGLE-01: a randomized, controlled trial comparing the efficacy and depth of insertion of single-and double-balloon enteroscopy by using a novel method to determine insertion depth. Gastrointest Endosc. 2012; 76(5):972-980.

[21] Takano N,Yamada A,Watabe H, et al. Single-balloon versus double-balloon endoscopy for achieving total enteroscopy: a randomized, controlled trial. Gastrointest Endosc. 2011; 73(4):734-739.

[22] Zhang MM,Yu YB,Zuo XL,Zheng WW,Li YQ. Deep enteroscopy diagnosis of obscure overt gastrointestinal bleeding due to intravascular endothelial hyperplasia missed by capsule endoscopy. Endoscopy. 2016; 48(Suppl 1 UCTN): E30-E32.

[23] Sun YN,Zuo XL,Wang X,Ma T,Li Z,Li YQ. Cryptogenic multifocal ulcerous stenosing enteritis diagnosed with single-balloon enteroscopy. Endoscopy. 2019; 51(5): E94-E95.

[24] Ma MJ,Li Z,Li YQ. Is it a refractory celiac disease? Gastroenterology. 2019; 156(1): e1-e2.

[25] Yang JZ,Zhang Y,Kou GJ,Li YQ. Jejunum hemolymphangioma causing refractory anemia in a young woman. Am J Gastroenterol. 2020; 115(6):810.

[26] May A,Färber M,Aschmoneit I, et al. Prospective multicenter trial comparing push-and-pull enteroscopy with the single-and double-balloon techniques in patients with small-bowel disorders. Am J Gastroenterol. 2010; 105(3):575-581.

[27] Lu ZJ,Qi Y,Weng JJ, et al. Efficacy and safety of single-balloon versus double-balloon enteroscopy: a single-center retrospective analysis. Med Sci Monit. 2017; 23:1933-1939.

[28] Li A,Chen FX,Li YQ. An unusual cause of recurrent melena. Gastroenterology. 2019; 157(2):311-312.

[29] Ma T,Liu GQ,Zuo XL. Phytobezoar-induced small-bowel obstruction successfully diagnosed and treated by single-balloon enteroscopy. Clin Gastroenterol Hepatol. 2017; 15(7): A23-A24.

[30] Upchurch BR,Sanaka MR,Lopez AR,Vargo JJ. The clinical utility of single-balloon enteroscopy: a single-center experience of 172 procedures. Gastrointest Endosc. 2010; 71(7):1218-1223.

[31] Frantz DJ,Dellon ES,Grimm IS,Morgan DR. Single-balloon enteroscopy: results from an initial experience at a U.S. tertiary-care center. Gastrointest Endosc. 2010; 72(2):422-426.

[32] Aktas H,Mensink PBF,Haringsma J,Kuipers EJ. Low incidence of hyperamylasemia after proximal double-balloon enteroscopy: has the insertion technique improved? Endoscopy. 2009; 41(8):670-673.

RIGHTS & PERMISSIONS

2024 The Author(s). Journal of Digestive Diseases published by Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.