Meckel's Diverticulum Diagnosed by Balloon-Assisted Enteroscopy: A Multicenter Report from the Taiwan Association for the Study of Small Intestinal Diseases (TASSID)

Abstract

Background and aims: Patients with Meckel's diverticulum (MD) are difficult to preoperatively diagnose because of its endoscopic inaccessibility. Balloon-assisted enteroscopy (BAE) allows endoscopic access to the entire small intestine. The aim of the current study was to investigate patients with MD diagnosed by BAE in Taiwan.

Methods: We conducted a retrospective, multicenter study of patients with MD who were diagnosed by BAE in Taiwan. The clinical characteristics, endoscopic features, histopathological findings, treatment methods, and outcomes were analyzed.

Results: A total of 55 patients with MD were enrolled (46 males and 9 females). The mean age at diagnosis was 34.1 years. Overt gastrointestinal bleeding (87.3%) was the primary indication for BAE, followed by abdominal pain (9.1%), suspected small bowel tumor (1.8%), and Crohn's disease follow-up (1.8%). The mean distance between the ileocecal valve and MD was 71.6 cm (regarding diagnostic yields: BAE-100%, capsule endoscopy-40%, Meckel's scan-35.7%, computed tomography-14.6%, small bowel series-12.5%, and angiography-11.1%; regarding endoscopic features of MD: a large ostium-89.1%, a small ostium-7.3%, and a polypoid mass-3.6%). Surgical treatment was performed in 76.4% patients, and conservative treatment was performed in 23.6% patients. The mean length of MD in 42 patients who underwent surgical resection was 5.2 cm (in 43 patients of MD with available histopathology: heterotopic gastric tissue, 42.4%, heterotopic gastric and pancreatic tissues, 7%; heterotopic pancreatic tissue, 4.7%; heterotopic colonic tissue, 2.3%; and a neuroendocrine tumor, 2.3%).

Conclusions: The current study showed BAE is a very useful modality for detecting MD compared with other conventional modalities.

Figure 1

Endoscopy showing a large ostium of Meckel's diverticulum (a); endoscopy showing a small ostium of Meckel's diverticulum (b); endoscopy showing an inverted polypoid mass from a Meckel's diverticulum (c).

Figure 2

Endoscopy showing an ulcer in the margin of Meckel's diverticulum (a); endoscopy showing several erosions in the orifice of Meckel's diverticulum (b); endoscopy showing a protruding vessel in the margin of Meckel's diverticulum (c).

Figure 3

Abdominal computed tomography showing a blind-ending gas-filled structure with surrounding fat stranding and in continuity with small bowel from the antimesenteric border of the ileum (arrow).

Figure 4

Technetium-99 m pertechnetate showing uptake (arrow) of ectopic gastric mucosa in the right lower quadrant of the abdomen, confirming the diagnosis of Meckel's diverticulum.

Figure 5

Capsule endoscopy showing two intestinal lumens in the distal ileum.

Figure 6

Digital angiography showing a contrast extravasation (arrow) from one of the branches of the superior mesenteric artery, confirming a bleeding Meckel's diverticulum.