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DOI: 10.1055/a-1459-4571
Water exchange-assisted versus carbon dioxide-insufflated single-balloon enteroscopy: a randomized controlled trial
Gefördert durch: National Natural Science Foundation of China 81472778Gefördert durch: National Natural Science Foundation of China 81571731
Gefördert durch: National Natural Science Foundation of China 81627807
Gefördert durch: Clinical New Techniques Project of Xijing Hospital XJGX13LZ02
Gefördert durch: Science Foundation of Shanxi Province 2018SF-161
Trial Registration: ClinicalTrials.gov (https://clinicaltrials.gov/) Registration number (trial ID): NCT01942863 Type of study: Prospective, Randomized, Controlled, Patient-blinded Trial
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Abstract
Background Single-balloon enteroscopy (SBE) is a valuable but difficult modality for the diagnosis and treatment of small-bowel disease. The water exchange method has the advantage of facilitating intubation during colonoscopy. Here, we evaluated the effects of water exchange on procedure-related variables related to SBE.
Methods This randomized controlled trial was conducted in a tertiary-care referral center in China. Patients due for attempted total enteroscopy were randomly allocated to undergo water exchange-assisted (water exchange group) or carbon dioxide-insufflated enteroscopy (CO2 group). All patients were planned to undergo both anterograde and retrograde procedures. The primary outcome was the total enteroscopy rate. Secondary outcomes included the maximal insertion depth, positive findings, procedural time, and adverse events.
Results: In total, 110 patients were enrolled, with 55 in each group. Baseline characteristics between the two groups were comparable. Total enteroscopy was achieved in 58.2 % (32/55) of the water exchange group and 36.4 % (20/55) of the control group (P = 0.02). The mean (standard deviation) estimated intubation depth was 521.2 (101.4) cm in the water exchange group and 481.6 (95.2) cm in the CO2 group (P = 0.04). The insertion time was prolonged in the water exchange group compared with the CO2 group (178.9 [45.1] minutes vs. 154.2 [27.6] minutes; P < 0.001). Endoscopic findings and adverse events were comparable between the two groups.
Conclusions: The water exchange method improved the total enteroscopy rate and increased the intubation depth during SBE. The use of water exchange did not increase the complications of enteroscopy.
* Contributed equally to this work
Publikationsverlauf
Eingereicht: 10. Oktober 2020
Angenommen nach Revision: 22. März 2021
Accepted Manuscript online:
22. März 2021
Artikel online veröffentlicht:
17. September 2021
© 2021. Thieme. All rights reserved.
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References
- 1 Chauhan SS, Manfredi MA, Abu Dayyeh BK. et al. Enteroscopy. Gastrointest Endosc 2015; 82: 975-990
- 2 Rondonotti E, Spada C, Adler S. et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2018; 50: 423-446
- 3 Yamamoto H, Sekine Y, Sato Y. et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 2001; 53: 216-220
- 4 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: 11-15
- 5 Gerson LB, Batenic MA, Newsom SL. et al. Long-term outcomes after double-balloon enteroscopy for obscure gastrointestinal bleeding. Clin Gastroenterol Hepatol 2009; 7: 664-669
- 6 Shishido T. Outcome of patients who have undergone total enteroscopy for obscure gastrointestinal bleeding. World J Gastroenterol 2012; 18
- 7 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: 575-581
- 8 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: 734-739
- 9 Domagk D, Mensink P, Aktas H. et al. Single- vs. double-balloon enteroscopy in small-bowel diagnostics: a randomized multicenter trial. Endoscopy 2011; 43: 472-476
- 10 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: 972-980
- 11 Messer I, May A, Manner H. et al. Prospective, randomized, single-center trial comparing double-balloon enteroscopy and spiral enteroscopy in patients with suspected small-bowel disorders. Gastrointest Endosc 2013; 77: 241-249
- 12 Rajan EA, Pais SA, DeGregorio BT. et al. Small-bowel endoscopy core curriculum. Gastrointest Endosc 2013; 77: 1-6
- 13 Kawamura T, Yasuda K, Tanaka K. et al. Clinical evaluation of a newly developed single-balloon enteroscope. Gastrointest Endosc 2008; 68: 1112-1116
- 14 Ramchandani M, Reddy DN, Gupta R. et al. Diagnostic yield and therapeutic impact of single-balloon enteroscopy: Series of 106 cases. J Gastroenterol Hepatol 2009; 24: 1631-1638
- 15 Lenz P, Meister T, Manno M. et al. CO2 insufflation during single-balloon enteroscopy: a multicenter randomized controlled trial. Endoscopy 2013; 46: 53-58
- 16 Li X, Zhao Y-J, 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: 1560-1565
- 17 Aquino J, Bernardo W, de Moura D. et al. Carbon dioxide versus air insufflation enteroscopy: a systematic review and meta-analysis based on randomized controlled trials. Endosc Int Open 2018; 06: E637-E645
- 18 Hasak S, Lang G, Early D. et al. Use of a transparent cap increases the diagnostic yield in antegrade single-balloon enteroscopy for obscure GI bleed. Dig Dis Sci 2019; 64: 2256-2264
- 19 Leung JW, Mann S, Leung FW. Options for screening colonoscopy without sedation: a pilot study in United States veterans. Aliment Pharmacol Therap 2007; 26: 627-631
- 20 Leung FWMS, Leung JW, Siao-Salera RM. et al. The water method is effective in difficult colonoscopy – it enhances cecal intubation in unsedated patients with a history of abdominal surgery. J Interv Gastroenterol 2011; 1: 172-176
- 21 Luo H, Zhang L, Liu X. et al. Water exchange enhanced cecal intubation in potentially difficult colonoscopy. Unsedated patients with prior abdominal or pelvic surgery: a prospective, randomized, controlled trial. Gastrointest Endosc 2013; 77: 767-773
- 22 Liang S, Pan Y, Wang B. et al. Complete small-bowel examination by oral single-balloon enteroscopy using the water-exchange method. Endoscopy 2013; 45 (Suppl. 02) E415-E417
- 23 Jia H, Pan Y, Guo X. et al. Water exchange method significantly improves adenoma detection rate: a multicenter, randomized controlled trial. Am J Gastroenterol 2017; 112: 568-576
- 24 Li X-B, Dai J, Chen H-M. et al. A novel modality for the estimation of the enteroscope insertion depth during double-balloon enteroscopy. Gastrointest Endosc 2010; 72: 999-1005
- 25 Rex DK, Petrini JL, Baron TH. et al. Quality indicators for colonoscopy. Am J Gastroenterol 2006; 101: 873-885
- 26 Aktas H, Mensink PB, Haringsma J. et al. Low incidence of hyperamylasemia after proximal double-balloon enteroscopy: has the insertion technique improved?. Endoscopy 2009; 41: 670-673
- 27 May A. How much importance do we have to place on complete enteroscopy?. Gastrointest Endosc 2011; 73: 740-742
- 28 Khashab MA, Lennon AM, Dunbar KB. et al. A comparative evaluation of single-balloon enteroscopy and spiral enteroscopy for patients with mid-gut disorders. Gastrointest Endosc 2010; 72: 766-772
- 29 Lenz P, Roggel M, Domagk D. Double- vs. single-balloon enteroscopy: single center experience with emphasis on procedural performance. Int J Colorectal Dis 2013; 28: 1239-1246
- 30 Leung JW, Siao-Salera R, Abramyan O. et al. Impact of water exchange colonoscopy on serum sodium and potassium levels: an observational study. Dig Dis Sci 2013; 59: 653-657
- 31 Wang X, Luo H, Xiang Y. et al. Left-colon water exchange preserves the benefits of whole colon water exchange at reduced cecal intubation time conferring significant advantage in diagnostic colonoscopy - a prospective, randomized controlled trial. Scand J Gastroenterol 2015; 50: 916-923