Double-balloon enteroscopy in the diagnosis and the management of small-bowel diseases: an initial experience in 40 patients

Abstract

Background: Double-balloon enteroscopy (DBE) is a new technique, recently described by its innovator, and it is seen to be beneficial in the diagnosis and management of small-bowel disease.

Objective: To evaluate this new technique in consecutive patients with suspected small-bowel disease.

Design: Single-center prospective study.

Setting: Tertiary referral hospital, conducted from July to December 2004.

Patients: Forty consecutive patients with suspected small-bowel disease referred for DBE, mean age of 58 years (range, 14-89 years), 17 men.

Interventions: Endoscopic biopsies or therapy was performed as clinically indicated.

Main outcome measurements: Significant diagnostic input and therapeutic intervention based on clinical outcomes.

Results: Indications included obscure GI bleeding (18), iron deficiency anemia (6), anemia of chronic disease (4), acute obscure GI bleeding (4), abdominal pain with other symptoms (4), Crohn's disease (3), and abdominal pain alone (1). Nineteen patients (47.5%) had a small-bowel finding, with 30 of 40 (75%) of the patients having a significant diagnostic input. Intervention was performed in 13 (32.5%) patients with success in 10 (77%). The only variable significantly associated with therapeutic success was a previous history of blood transfusions (p < 0.01). This was the only independent predictor identified by multiple logistic regression analysis (Odds ratio 13.5: 95% confidence interval [1.5, 120]). One perforation from contact diathermy occurred. In 10 attempts at total enteroscopy, none were successful.

Limitations: Nonblinded nonrandomized study.

Conclusions: These early data suggest DBE to be effective in the diagnosis and the therapy of small-bowel disease, particularly those patients with a history of blood transfusion.