Study examining large-scale data of double balloon enteroscopy shows it is safe and effective
A large-scale data review by researchers in China of double balloon enteroscopy (DBE) over the last decade showed the endoscopic procedure to be safe and effective for detection of diseases of the small intestine. DBE had a pooled detection rate of 68.1 percent for all small intestinal disease. Suspected mid-gastrointestinal bleeding was found to be the most common indication, with a relatively high detection rate. Inflammatory lesions and vascular lesions were the most common findings in patients with suspected mid-gastrointestinal bleeding. The study appears in the September issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE).
Balloon assisted or "deep" enteroscopy is a procedure which can allow the advancement of a long endoscope (called an enteroscope) into the small intestine for both diagnostic and therapeutic purposes. Balloon assisted enteroscopy may use a one or two balloon system. The system using two balloons is called double balloon enteroscopy (DBE). The balloon assisted enteroscopy technique advances the endoscope through the small bowel by alternately inflating and deflating balloons, and pleating the small bowel over an insertion tube like a curtain over a rod. The procedure can be performed via the upper gastrointestinal (GI) tract (antegrade) or through the lower GI tract (retrograde).The procedure is indicated for patients who have problems in the small intestine including bleeding, strictures, abnormal tissue, polyps, or tumors. Since the first article introducing DBE was published in GIE: Gastrointestinal Endoscopy in 2001, DBE has been widely used in clinical practice worldwide.
Up until now, there have been many published original articles across the world addressing the technical aspects and positive findings of DBE. However, most of these studies were of small sample size and show inconsistent, if not controversial, data among different settings and in different countries. Therefore, the researchers performed this systematic review of all eligible studies related to diagnostic DBE during the decade of development in order to produce state-of-the-art data on indications, lesion detection rate, total enteroscopy, and complications in examining diseases of the small intestine.
The researchers, led by Zhuan Liao, MD, and Zhao-Shen Li, MD, Department of Internal Medicine, Changhai Hospital, Second Military Medical University, Shanghai, China, searched PubMed between January 1, 2001 and March 31, 2010 for original articles about DBE evaluation of diseases of the small intestine. Data on total number of procedures, distribution of indications, pooled detection rate, pooled total enteroscopy rate, and composition of positive findings were extracted and/or calculated. In addition, the data involving DBE-associated complications were analyzed. Indications were defined as the primary reasons for DBE. DBE findings that could explain the symptoms of the patient and resulted in a change in therapeutic management were considered positive findings, and these included any clinically significant findings in the entire GI tract. Total enteroscopy was defined when the entire small intestine was successfully visualized. Complications of DBE were defined as any adverse events that occurred during and after the procedures and were divided into minor and major categories. Minor complications included GI symptoms such as nausea, vomiting, abdominal distension, and other transient and self-limiting symptoms. Major complications included any severe adverse events that required hospitalization and/or an endoscopic or surgical intervention and/or contributed to the death of the patient.
A total of 66 English-language original articles involving 12,823 procedures were included. Suspected mid-gastrointestinal bleeding was the most common indication (62.5 percent), followed by symptoms and signs only (7.9 percent), small intestine obstruction (5.8 percent), and Crohn's disease (5.8 percent). The pooled detection rates were as follows: suspected mid-gastrointestinal bleeding (68.1 percent), symptoms and signs only (68 percent), Crohn's disease (53.6 percent), and small intestine obstruction (63.4 percent). The overall detection rate was 85.8 percent. Inflammatory lesions (37.6 percent) and vascular lesions (65.9 percent) were the most common findings, respectively, in suspected mid-gastrointestinal bleeding patients of Eastern and Western countries. The pooled total enteroscopy rate was 44 percent by combined or antegrade-only approach. The pooled minor and major complication rates were 9.1 percent and 0.72 percent, respectively.
The researchers concluded that the detection rate and complication rate of DBE are acceptable. They found that DBE is a valuable modality, with a pooled detection rate of 68.1 percent for all small intestinal disease. Inflammatory lesions and vascular lesions are the most common findings in patients with suspected mid-gastrointestinal bleeding in Eastern and Western countries, respectively, according to DBE. Although DBE failed to identify a proportion of lesions, they consider that the performance of DBE is acceptable because the symptoms of a significant proportion of patients without positive findings would not recur during follow-up. They noted that DBE is considered to be a safe procedure with few complications, most of which are minor.
In an accompanying editorial, Andrew S. Ross, MD, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Wash., stated, "
we finally have composite large-scale data to support what we have suspected - DBE performed in appropriately selected individuals is a highly useful and extremely safe clinical tool that can be used for a variety of indications for deep enteroscopy. Although it is clearly an improvement over technologies of the past, DBE is not without its limitations and does not provide an answer in every patient. No amount of data can replace clinical vigilance and long-term follow-up. In the case of small-bowel disorders and obscure GI bleeding in particular, it is up to us as endoscopists to selectively choose from the now-myriad selection of devices within our toolbox that can help us to solve what is often a vexing clinical problem."
Provided by American Society for Gastrointestinal Endoscopy
- Unique gastroenterology procedure developed in adults shows promise in pediatrics Sep 27, 2010 | not rated yet | 0
- Study identifies double-balloon enteroscopy as cost-effective approach for obscure GI bleeding Nov 24, 2008 | not rated yet | 0
- New Procedure Allows Diagnosis, Treatment of Small Intestine without Surgery (w/ Video) Jan 11, 2010 | not rated yet | 0
- Capsule endoscopy diagnoses more Crohn's disease recurrence after surgery than colonoscopy Sep 26, 2007 | not rated yet | 0
- Transarterial embolization is a safe, nonoperative option for acute peptic ulcer bleeding May 23, 2011 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
High blood glucose is associated with poor outcomes in hospitalized patients, and use of intensive insulin therapy (IIT) to control hyperglycemia is a common practice in hospitals. But the recent evidence does not show a ...
Other May 24, 2013 | 4 / 5 (1) | 0
Two out of five medical students have an unconscious bias against obese people, according to a new study by researchers at Wake Forest Baptist Medical Center. The study is published online ahead of print in the Journal of ...
Other May 23, 2013 | not rated yet | 0
Nanyang Technological University's (NTU) new medical school will be pioneering the use of plastinated bodies for medical education in Singapore.
Other May 23, 2013 | not rated yet | 0
A 2012 survey of internal medicine residents at Massachusetts General Hospital (MGH) – one of the nation's leading teaching hospitals – found that more than half rated the training they had received in addiction and other ...
Other May 22, 2013 | 5 / 5 (1) | 0
Early use of tracheostomy for mechanically ventilated patients not associated with improved survival
For critically ill patients receiving mechanical ventilation, early tracheostomy (within the first 4 days after admission) was not associated with an improvement in the risk of death within 30 days compared to patients who ...
Other May 21, 2013 | not rated yet | 0
(Medical Xpress)—A new study by researchers in the US has shown that an ancient virus can be modified to help in the fight against the simian immunodeficiency virus SIV, which is the equivalent in monkeys ...
21 hours ago | 5 / 5 (3) | 0 |
Two mutations central to the development of infantile myofibromatosis (IM)—a disorder characterized by multiple tumors involving the skin, bone, and soft tissue—may provide new therapeutic targets, according to researchers ...
15 hours ago | 3 / 5 (2) | 0 |
Women at a particular stage in their monthly menstrual cycle may be more vulnerable to some of the psychological side-effects associated with stressful experiences, according to a study from UCL.
18 hours ago | 3.7 / 5 (3) | 0 |
Ernie Pyle – an iconic war correspondent in World War II – reportedly said "There are no atheists in foxholes." A new joint study between two brothers at Cornell and Virginia Wesleyan found that only ...
21 hours ago | 2.5 / 5 (4) | 2
How can healthy people who hear voices help schizophrenics? Finding the answer for this is at the centre of research conducted at the University of Bergen.
21 hours ago | 4 / 5 (2) | 2
Biological processes are generally based on events at the molecular and cellular level. To understand what happens in the course of infections, diseases or normal bodily functions, scientists would need to ...
18 hours ago | 5 / 5 (5) | 0 |