Capsule endoscopy and single-balloon enteroscopy in small bowel diseases: Competing or complementary?

AIM To evaluate diagnostic yields of capsule endoscopy(CE) and/or single-balloon enteroscopy(SBE) in patients with suspected small bowel diseases.METHODS Were trospectively analyzed 700 patients with suspected small bowel diseases from September 2010 to March 2016. CE, SBE, or SBE with prior CE was performed in 401, 353, and 47 patients, respectively. Data from clinical and endoscopy records were collected for analysis. Indications, procedure times, diagnostic yields, and complications were summarized and evaluated.RESULTS The overall diagnostic yield for the CE group was 57.6%. The diagnostic yield of CE in patients with obscure gastroin testinal bleeding(OGIB) was significantly greater than that in patients with no bleeding(70.5% vs 43.8%, P < 0.01). The overall diagnostic yield of SBE was 69.7%. There was no difference in the diagnostic yield of SBE between patients with OGIB and those with no bleeding(72.5% vs 68.9%, P = 0.534). Forty-seven patients underwent CE prior to SBE. Among them, the diagnostic yield of SBE with positive findings on prior CE was 93.3%. In addition, SBE detected two cases with superficial ulcer and erosive lesions in the small bowel, which were missed by CE. However, one case with lymphoma and two with Crohn's disease were not confirmed by SBE. The rate of capsule retention was 2.0%. There were no significant complications during or after SBE examinations.CONCLUSION SBE is a safe and effective technique for diagnosing small bowel diseases. SBE with prior CE seemed to improve the diagnostic yield of small bowel diseases.

Ileal gallstone obstruction:Single-balloon enteroscopic removal

Gallstone-induced ileus is a rare complication of cholelithiasis.Since localization of gallstones impacted in the small bowel,especially in the ileum,prevents access by conventional endoscopy in most cases,the mainstay of treatment remains surgical.Recent invention of double-and single-balloon enteroscopy has added much to the ability of imaging the small bowel and enables endoscopically directed therapy.Herein,for the first time,we report a successful endoscopic calculus removal via peroral single-balloon enteroscopy in an 81-year-old woman suffering from gallstone ileus of the ileum.

Current status of single-balloon enteroscopy: Insertability and clinical applications

The single-balloon enteroscopy(SBE) system was launched in 2007, proposed as a simpler method than double-balloon enteroscopy(DBE). Controversy surrounds whether the SBE system has the same insertability as DBE. However, many methods have been proposed to improve the depth of insertion with the SBE system, involving several techniques and endoscopic accessories. SBE is used for investigating not only small bowel diseases, but also diseases of the pancreatobiliary and colonic structures. SBE is a necessary advancement for many endoscopic procedures and applications in modern clinical practice. In our review, we summarized the current literature concerning the insertability of SBE and described the technical aspects of improving the rate of deep insertion in SBE procedures. In addition, the recent applications of SBE to diseases besides those of the small bowel are described.

Single-balloon and spiral enteroscopy may have similar diagnostic and therapeutic yields to double-balloon enteroscopy:Results from a meta-analysis of randomized controlled trials and prospective studies

BACKGROUND Double-balloon,single-balloon,and spiral enteroscopy(DBE,SBE,and SE)have revolutionized the management of intestinal diseases.However,evidence about efficacies of these methods is lacking.We aimed to conduct a meta-analysis comparing the clinical outcomes among DBE,SBE,and SE.METHODS We searched randomized controlled trials and prospective studies in MEDLINE,PubMed,EMBASE,Cochrane Library,and Chinese CQVIP database.Studies referencing the comparison of at least two of these three methods were included.Primary outcome was diagnostic yield.Other outcomes were therapeutic yield,total enteroscopy,examination time,time to maximum insertion,and depth of maximal insertion(DMI).RESULTS Eleven studies including 727 patients were identified:DBE vs SE(n=6),DBE vs SBE(n=4),and SBE vs SE(n=1).The diagnostic and therapeutic yields did not differ significantly when comparing DBE with SE[odds ratio(OR)=1.19,95%confidence interval(CI):0.68-2.08;OR=1.17,95%CI:0.61-2.23]and DBE with SBE(OR=0.85,95%CI:0.55-1.33;OR=1.71,95%CI:0.64-4.60).Total enteroscopy,examination time,time to maximum insertion,and DMI were similar between SBE and DBE.DBE was superior to SE with regard to DMI[mean difference(MD)=36.76,95%CI:5.09-68.43],with longer time to maximum insertion(MD=15.14,95%CI:12-18.27)and examination time(MD=12.98,95%CI:9.57-16.38).CONCLUSION DBE and SBE have similar clinical outcomes.Compared with DBE,SE seems to have similar diagnostic and therapeutic yields,but shorter procedural time in cost of less depth of insertion.SE needs further evaluation vs SBE.DBE is recommended for complete enteroscopy.

Computed tomography three-dimensional reconstruction in the diagnosis of bleeding small intestinal polyps:A case report

BACKGROUND Computed tomography(CT)small bowel three-dimensional(3D)reconstruction is a powerful tool for the diagnosis of small bowel disease and can clearly show the intestinal lumen and wall as well as the outside structure of the wall.The horizontal axis position can show the best adjacent intestinal tube and the lesion between the intestinal tubes,while the coronal position can show the overall view of the small bowel.The ileal end of the localization of the display of excellent,and easy to quantitative measurement of the affected intestinal segments,the sagittal position for the rectum and the pre-sacral lesions show the best,for the discovery of fistulae is also helpful.Sagittal view can show rectal and presacral lesions and is useful for fistula detection.It is suitable for the assessment of inflammatory bowel disease,such as assessment of disease severity and diagnosis and differential diagnosis of the small bowel and mesenteric space-occupying lesions as well as the judgment of small bowel obstruction points.CASE SUMMARY Bleeding caused by small intestinal polyps is often difficult to diagnose in clinical practice.This study reports a 29-year-old male patient who was admitted to the hospital with black stool and abdominal pain for 3 months.Using the combination of CT-3D reconstruction and capsule endoscopy,the condition was diagnosed correctly,and the polyps were removed using single-balloon enteroscopyendoscopic retrograde cholangiopancreatography without postoperative complications.CONCLUSION The role of CT-3D in gastrointestinal diseases was confirmed.CT-3D can assist in the diagnosis and treatment of gastrointestinal diseases in combination with capsule endoscopy and small intestinal microscopy.

Intermittent melena and refractory anemia due to jejunal cavernous lymphangioma:A case report

BACKGROUND Lymphangiomas in the gastrointestinal tract are extremely rare in adults.As a benign lesion,small intestine lymphangiomas often remain asymptomatic and pose challenges for definitive diagnosis.However,lymphangiomas can give rise to complications such as abdominal pain,bleeding,volvulus,and intussusception.Here,we report a case of jejunal cavernous lymphangioma that presented with intermittent melena and refractory anemia in a male adult.CASE SUMMARY A 66-year-old man presented with intermittent melena,fatigue and refractory anemia nine months prior.Esophagogastroduodenoscopy and colonoscopy were performed many times and revealed no apparent bleeding.Conservative management,including transfusion,hemostasis,gastric acid secretion inhibition and symptomatic treatment,was performed,but the lesions tended to recur shortly after surgery.Ultimately,the patient underwent capsule endoscopy,which revealed a more than 10 cm lesion accompanied by active bleeding.After singleballoon enteroscopy and biopsy,a diagnosis of jejunal cavernous lymphangioma was confirmed,and the patient underwent surgical resection.No complications or recurrences were observed postoperatively.CONCLUSION Jejunal cavernous lymphangioma should be considered a cause of obscure gastrointestinal bleeding.Capsule endoscopy and single-balloon enteroscopy can facilitate diagnosis.Surgical resection is an effective management method.

Performance characteristics of retrograde single-balloon endoscopy: A single center experience

AIM: To evaluate the technical success, diagnostic yield(DY) and therapeutic potential of retrograde single balloon enteroscopy(rS BE). METHODS: A retrospective review of 136 rS BE procedures performed at a tertiary academic referral center from January 2006 and September 2013 was completed. Patient characteristics including age, gender and inpatient status were collected. The indication for the procedure was categorized into one of three groups: Obscure gastrointestinal bleeding(GIB), evaluation for Crohn's disease and abnormal imaging. Procedural characteristics including insertion depth(ID), procedure time, concordance with pre-procedural imaging and complications were also recorded. Lastly, DY, defined as the percentage of cases producing either a definitive diagnosis or findings that could explain clinical symptoms and therapeutic yield(TY), defined as the percentage of cases in which a definitive intervention was performed, were determined. Mucosal tattooing and biopsy alone were not included in the TY. RESULTS: A total of 136 rS BE procedures were identified. Mean patient age was 57.5(± 16.2) years, 67(49.2%) were male, and 110(80.9%) procedures were performed on an outpatient basis. Indications for rS BE included GIB in 55(40.4%), evaluation of inflammatory bowel disease(IBD) in 29(21.3%), and imaging suggestive of pathology other than GIB or IBD in 43(31.6%). Nine(6.6%) rS BEs were performed for other indications. Mean ID was 68.3(± 39.3) cm proximal to the ileocecal valve and mean time to completion was 41.7(± 15.5) min. Overall, 73(53.7%) cases were diagnostic and 25(18.4%) cases were therapeutic in which interventions(argon plasma coagulation, stricture dilatation, polypectomy, etc.) were performed. Pre-procedural imaging was performed in 88(64.7%) patients. Endoscopic concordance of positive imaging findings was seen in 31(35.2%) cases. Follow up data was available in 93(68.4%) patients; 2(2.2%) reported post-procedural abdominal pain within 30 d following rS BE. There were no other reported complications. CONCLUSION: rS BE exhibits an acceptable diagnostic and TY, rendering it a safe and effective procedure for the evaluation and treatment of small bowel diseases.

Ameta-analysis on efficacy and safety:single-balloon vs.double-balloon enteroscopy

Background and aim:Double-balloon enteroscopy(DBE)and single-balloon enteroscopy(SBE)are new techniques capable of providing deep enteroscopy.Results of individual studies comparing these techniques have not been able to identify a superior strategy.Our aim was to systematically pool all available studies to compare the efficacy and safety of DBE with SBE for evaluation of the small bowel.Methods:Databases were searched,including PubMed,Embase,and the Cochrane Central Register of Controlled Trials.The main outcome measures were complete small-bowel visualization,diagnostic yield,therapeutic yield,and complication rate.Statistical analysis was performed using Review Manager(RevMan version 5.2).Meta-analysis was performed using fixed-effect or random-effect methods,depending on the absence or presence of significant heterogeneity.We used the v2 and I2 test to assess heterogeneity between trials.Results were expressed as risk ratios(RR)or mean differences with 95%confidence intervals(CI).Results:Four prospective,randomized,controlled trials with a total of 375 patients were identified.DBE was superior to SBE for visualization of the entire small bowel[pooled RR=0.37(95%CI:0.19–0.73;P=0.004)].DBE and SBE were similar in ability to provide diagnosis[pooled RR=0.95(95%CI:0.77–1.17;P=0.62)].There was no significant difference between DBE and SBE in therapeutic yield[pooled RR=0.78(95%CI:0.59–1.04;P=0.09)]and complication rate[pooled RR=1.08(95%CI:0.28–4.22);P=0.91].Conclusions:DBE was superior to SBE with regard to complete small bowel visualization.DBE was similar to SBE with regard to diagnostic yield,ability to provide treatment and complication rate,but these results should be interpreted with caution as they is based on very few studies and the overall quality of the evidence was rated as low tomoderate,due to the small sample size.

Endoscopic treatment of blue rubber bleb nevus syndrome in a 4-year-old girl with long-term follow-up:A case report

BACKGROUND Blue rubber bleb nevus syndrome(BRBNS)is a rare vascular disease,difficult to diagnose and choose a treatment method,especially in young children.There are several limiting factors to the use of enteroscopy for diagnostics and treatment in pediatric patients,in general.The literature on BRBNS cases is limited and presents various therapeutic approaches.CASE SUMMARY We present here a case of BRBNS involving a 4-year-old female,whose intestinal venous lesions were successfully treated by endoscopic sclerotherapy and aethoxysklerol foam.Skin lesions,typical for BRBNS,appeared on the 8th d of the child’s life and their number increased over the next several months.The child also experienced episodes of critical decrease in hemoglobin level(by as much as 52 g/L)for several years,requiring iron supplementation and several blood transfusions.Video capsule endoscopy revealed numerous vascular formations in the small bowel.The combined findings of gastrointestinal venous formations and skin lesions prompted BRBNS diagnosis.Single-balloon enteroscopy was used to perform sclerotherapy,with aethoxysklerol foam.A positive effect was observed within 19 mo of follow-up.We continue to monitor the patient’s hemoglobin level,every 2 wk,and it has remained satisfactory(>120 g/L).CONCLUSION Endoscopic sclerotherapy can be effective in the clinical management of gastrointestinal manifestations of BRBNS in young children.

短型单气囊小肠镜在胃切除Roux-en-Y吻合术后患者ERCP诊疗的初步应用体会

目的探讨短型单气囊小肠镜(sSBE)在胃切除Roux-en-Y吻合术后胆胰疾病患者经内镜逆行性胰胆管造影术(ERCP)诊疗中的初步应用体会。方法回顾性分析12例胃切除Roux-en-Y吻合术后胆胰疾病患者的临床资料,其中9例为全胃切除术后Roux-en-Y吻合,3例为远端胃大部切除术后Roux-en-Y吻合,分析采用短型单气囊小肠镜行ERCP诊疗的临床资料和过程,总结完成情况及并发症发生情况。结果12例胃切除Roux-en-Y吻合术后胆胰疾病患者(其中胆总管结石10例,壶腹部肿瘤伴梗阻性黄疸1例,胃癌术后肝门部淋巴结转移伴梗阻1例)成功到达乳头并完成操作9例(75.0%),3例未能到达乳头(25.0%),术后发生ERCP术后胰腺炎2例(22.2%),经内科治疗后痊愈,无穿孔、消化道出血、死亡等严重并发症发生。结论短型单气囊小肠镜应用在胃切除Roux-en-Y吻合术后患者ERCP诊疗中是安全和有效的,但操作时间总体较长,对操作者的技术要求较高,此类患者需结合具体病情选择合适的处理方法。