The role of double-balloon enteroscopy in diagnosis and management of incomplete small-bowel obstruction

Background and study aims:Double-balloon enteroscopy (DBE) is a newly developed endoscopic technique for investigating various small-bowel diseases. The aim of this study was to evaluate the diagnostic yield and therapeutic impact of DBE in patients with incomplete small-bowel obstruction (SBO).

Patients and methods: This study is a prospective analysis of 45 consecutive patients specifically referred to our hospital between December 2004 and January 2006 for investigation of incomplete SBO that had been confirmed by both clinical symptoms and imaging tests. Patients with a high suspicion of postoperative adhesion were excluded and DBE was performed in stable patients. The final management was guided by the results of DBE and radiographic studies. Demographic, clinical, procedural, and outcome data were collected for analysis.

Results: A total of 30 DBEs were performed in 29 patients (11 women, 18 men; mean age 52.0 ± 13.5 years). DBE identified causes of incomplete SBO in 27 patients (93.1 %) and allowed histopathologic evaluation in 17 patients (58.6 %). The more common abnormalities detected were small-bowel tumors (48.3 %) and strictures caused by Crohn’s disease (24.1 %). In detecting small-bowel abnormalities, DBE showed a sensitivity of 96.4 %, a specificity of 100 %, a positive predictive value of 100 %, and a negative predictive value of 50 %. DBE influenced the therapeutic strategy in 41.4 % of patients by adding more information regarding appropriate treatment. Follow-up data were obtained for 26 patients (89.7 %), for a mean 9.4 months (range 4 - 18 months). Of the 26 patients with follow-up, 21 (72.4 %) had no further SBO.

Conclusions: Double-balloon enteroscopy is a feasible diagnostic tool for detecting the causes of incomplete SBO in patients without a history of abdominal surgery and also influences therapy in patients without a definite cause detected by conventional radiography.

References

• 1 Brochwicz-Lewinski M J, Paterson-Brown S, Murchison J T. Small-bowel obstruction - the water-soluble follow-through revisited.  Clin Radiol. 2003;  58 393-397
• 2 Scaglione M, Romano S, Pinto F. et al . Helical CT diagnosis of small-bowel obstruction in the acute clinical setting.  Eur J Radiol. 2004;  50 15-22
• 3 Burkill G, Bell J, Healy J. Small-bowel obstruction: the role of computed tomography in its diagnosis and management with reference to other imaging modalities.  Eur Radiol. 2001;  11 1405-1422
• 4 May A, Nachbar L, Wardak A. et al . Double-balloon enteroscopy: preliminary experience in patients with obscure gastrointestinal bleeding or chronic abdominal pain.  Endoscopy. 2003;  35 985-991
• 5 Yamamoto H, Kita H, Sunada K. et al . Clinical outcomes of double-balloon enteroscopy for diagnosis and treatment of small intestinal diseases.  Clin Gastroenterol Hepatol. 2004;  2 1010-1016
• 6 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
• 7 Heine G D, Hadithi M, Groenen M J. et al . Double-balloon enteroscopy: indications, diagnostic yield, and complications in a series of 275 patients with suspected small-bowel disease.  Endoscopy. 2006;  38 42-48
• 8 Manabe N, Tanaka S, Fukumoto A. et al . Double-balloon enteroscopy in patients with GI bleeding of obscure origin.  Gastrointest Endosc. 2006;  64 135-140
• 9 Yamamoto H, Sekine Y, Sato Y. et al . Total enteroscopy with a nonsurgical steerable double-balloon method.  Gastrointest Endosc. 2001;  53 216-220
• 10 Obuz F, Terzi C, Sokmen S. et al . The efficacy of helical CT in the diagnosis of small-bowel obstruction.  Eur J Radiol. 2003;  48 299-304
• 11 Zissin R, Hertz M, Gayer G. et al . Congenital internal hernia as a cause of small-bowel obstruction: CT findings in 11 adult patients.  Br J Radiol. 2005;  78 796-802
• 12 Delabrousse E, Destrumelle N, Brunelle S. et al . CT of small-bowel obstruction in adults.  Abdom Imaging. 2003;  28 257-266
• 13 Mishkin D S, Chuttani R, Croffie J. et al . ASGE technology status evaluation report: wireless capsule endoscopy.  Gastrointest Endosc. 2006;  63 539-545
• 14 Zissin R, Hertz M, Paran H. et al . SBO secondary to Crohn disease: CT findings.  Abdom Imaging. 2004;  29 320-325
• 15 Oshitani N, Yukawa T, Yamagami H. et al . Evaluation of deep small-bowel involvement by double-balloon enterosopy in Crohn’s disease.  Am J Gastroenterol. 2006;  101 1-6
• 16 Monkemuller K, Weigt J, Treiber G. et al . Diagnostic and therapeutic impact of double-balloon enteroscopy.  Endoscopy. 2006;  38 67-72
• 17 Lo S K, Mehdizadeh S. Therapeutic uses of double-balloon enteroscopy.  Gastrointest Endosc Clin N Am. 2006;  16 363-376
• 18 Bo S, Elizabeth R, Shidan C. et al . Diagnostic yield and therapeutic impact of double-balloon enteroscopy in a large cohort of patients with obscure gastrointestinal bleeding.  Am J Gastroenterol. 2006;  101 2011-2015