Preliminary colonoscopy facilitates retrograde double-balloon enteroscopy

Background and study aims: Retrograde double-balloon enteroscopy (RDBE) has a high failure rate due to difficulty intubating the ileo-cecal (IC) valve. We examined the utility of a pre-RDBE colonoscopy using a pediatric colonoscope to clean the cecum and perform an initial intubation of the IC valve.

Patients and methods: This study is a retrospective review of RDBE procedures for 45 patients at a single tertiary-care center to examine the success of IC intubation, maximal depth of enteroscope insertion, and duration of the procedure.

Results: The IC intubation success rate among patients who underwent RDBE using this novel method was 100 % as compared to 72.7 % using the traditional method (P < 0.003).

Conclusions: RDBE preceded by colonoscopy had a significantly higher IC intubation success rate, compared to RDBEs performed using the traditional method. Results support the use of this novel method when IC valve intubation using standard methods is difficult, and it may limit the need for repeat procedures or the use of other modalities for examining the small bowel.

• References

• 1 Yamamoto H, Sekine Y, Sato Y et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 2001; 53: 216-220
• 2 Mehdizadeh S, Han NJ, Cheng DW et al. Success rate of retrograde double-balloon enteroscopy. Gastrointest Endosc 2007; 65: 633-639
• 3 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: 62-70
• 4 Ell C, May A, Nachbar L et al. Push-and-pull enteroscopy in the small bowel using the double-balloon technique: results of a prospective European multicenter study. Endoscopy 2005; 37: 613-616
• 5 Heine GDN, Hadithi M, Groenen MJM et al. Double-balloon enteroscopy: indications, diagnostic yield, and complication in a series of 275 patients with suspected small-bowel disease. Endoscopy 2006; 38: 42-48
• 6 Yamamoto H, Kita H, Sunada K et al. Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol 2004; 2: 1010-1016
• 7 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 US tertiary care centers. Gastrointest Endos 2006; 64: 740-750
• 8 Gay G, Delvaux M. Double-balloon colonoscopy after failed colonoscopy: a pilot series with a new instrument. Endoscopy 2007; 39: 788-792
• 9 SPSS Version 15.0 for Windows. Chicago: SPSS Inc; 2007
• 10 Despott E, Fraser C. Achieving successful ileal intubation during retrograde double balloon enteroscopy: description of a novel, alternative technique. Endoscopy 2009; 41: E309-E310
• 11 Ross A, Waxman I, Semrad C et al. Balloon-assisted intubation of the ileocecal valve to facilitate retrograde double balloon enteroscopy. Gastrointest Endosc 2005; 62: 987-988