[Diagnostic and therapeutic utility of double balloon endoscopy: experience with 225 procedures].

INTRODUCTION: Double balloon enteroscopy (DBE) is a new endoscopic method for the examination of the small intestine.

OBJECTIVE: To determine the diagnostic yield and therapeutic utility of DBE.

PATIENTS AND METHODS: All patients undergoing DBE using a Fuji-non intestinoscope for suspected small bowel diseases during a 2 1/2 year period were studied in a prospective single-center cohort study. All patients underwent prior EGD and colonoscopy. Patients underwent small bowel cleansing on the day before the procedure using a standard colon lavage solution.

RESULTS: 225 DBE in 178 patients, (95 males, 83 females; mean age 59 years-old, range 12-93); oral route (n=160), anal (n=65). Indications (one or more per patient): GI bleeding (n=83), suspected Crohn's disease or evaluation of small bowel involvement or complications (n=35), diarrhea or malabsorption or suspected celiac disease (n=11), polyp removal in Peutz-Jeghers' syndrome or familial polyposis (n=23), tumor surveillance or search of primary tumor (n=14), abdominal pain (n=6) and miscellaneous (n=6). Mean duration of the procedure was 50 min, range 20 min to 150 min. Mean radiation exposure: 206 d Gy/cm2 (range 0-1492). The overall mean depth of small bowel insertion was 180 cm, ranging from 5 cm to the entire small bowel (650 cm). The mean depth of insertion via the oral route was 240 cm (range 20 cm to 650 cm) and via the anal route it was 65 cm (range 10 cm a 150 cm). A new diagnosis was reached in 108/178 patients (60%). Findings included: angiodysplasia, ulcerations, stenosis, polyps, portal jejunopathy, ischemic jejunitis and normal. DBE resulted in a therapeutic intervention (endoscopic, medical or surgical, excluding blood transfiusions) in 64% (115/178) of the patients.

CONCLUSIONS: DBE was clinically useful for reaching a new diagnosis and to start new therapies, change existing therapies, and perform an operative intervention or to provide therapeutic endoscopy in two-thirds of the investigated patients. DBE is a useful and safe method to obtain tissue for diagnosis, to provide hemostasis and to perform polypectomy.