Small-bowel endoscopy

Novel single-balloon enteroscopy for diagnosis and treatment of the small intestine: preliminary experiences. (Tsujikawa et al. Endoscopy 2008 [1])

Double-balloon enteroscopy (DBE) has been a major breakthrough in small-bowel imaging and therapy [2] [3] [4] [5] [6]. Until recently the major types of balloon enteroscopes available for investigation of the small bowel were the diagnostic and therapeutic Fujinon® enteroscopes [2] [3] [4] [5] [6]. Tsujikawa from Japan developed and presented the first large feasibility study using the single-balloon enteroscope (Olympus®, Japan) [6]. A total of 78 procedures were performed in 41 patients, with standard indications such as obscure gastrointestinal bleeding, diarrhea, and Crohn’s disease. The mean procedure time was 62.8 ± 20.2 minutes and 70.4 ± 19.3 minutes for the oral and anal routes, respectively. Among 24 patients in whom total enteroscopy was attempted, the entire small intestine was explored in six (25 %) [1]. The authors concluded that single-balloon enteroscopy (SBE) is not only easy to perform, due to the single balloon, but it can also safely lead to examination of the entire small intestine. Therefore, SBE is a useful diagnostic and therapeutic tool in addition to DBE for investigating suspected small-bowel disease.

When performing enteroscopy using DBE and SBE, the enteroscope is manipulated using the push and pull method [2] [3] [4] [5] [6]. The overtube helps to stabilize the small bowel and the inflated balloon on the tip prevents the intestine from sliding forward, keeping it “pulled proximally”, while the enteroscope is being advanced deeply into the small bowel [2] [7]. In essence, the major technical principle that allows a deep small-bowel intubation is the presence of an overtube with a balloon [1] [2] [3] [4] [5] [6]. Thus, nowadays a unifying terminology for DBE and SBE could be “balloon-enteroscopy” or balloon-assisted enteroscopy“ [7].

Few other reports demonstrating the SBE technique have been published over the past 12 months [8] [9]. The interest shown in novel balloon-assisted methods to perform small-bowel endoscopy is reflected by another feasibility study using a two-balloon add-on disposable element, which can be attached to various types of endoscopes, including a gastroscope [10]. Using this balloon-guided endoscopy (BGE) method Adler et al. were able to intubate a mean 175 cm of small bowel [10]. Whether these new techniques of SBE and BGE will have an advantage or be similar to the currently established DBE method will need to be explored in further studies. There is a persistent concern that flexion of the nonballoon-covered enteroscope using the SBE technique may result in mucosal or transmural laceration injuries. Similarly, the results of larger studies using the BGE method will need to be compared with the established standard of DBE.

References

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