Indication, Location of the Lesion, Diagnostic Yield, and Therapeutic Yield of Double-Balloon Enteroscopy: Seventeen Years of Experience

Abstract

Double-balloon enteroscopy (DBE) has become one of the standard methods in the diagnosis and treatment of small bowel (SB) disease. However, previous studies for DBE have limitations due to heterogeneity of indications and operators. The aim was to investigate the indication, location of the lesion, diagnostic yield, and therapeutic yield of DBE based on long-term data from a single operator. A retrospective study was performed by reviewing medical records of subjects who had received DBE at our unit in the past 17 years. Overall diagnostic yield was 78.7% (210/267). The diagnostic yield for obscure gastrointestinal bleeding (OGIB) was 68.3% (84/123). The diagnostic yield for OGIB was significantly lower (p < 0.001) than that for other indications. Therapeutic yield was 24.7% (66/267). Complications occurred in 7 (2.6%). Crohn’s disease, intestinal tuberculosis, nonsteroidal anti-inflammatory drug enteropathy, and diverticular lesions were mainly found in the ileum. Vascular lesions, non-specific inflammation, and neoplastic lesions were found more frequently in the jejunum. DBE is an excellent and safe endoscopic method for the diagnosis and treatment of SB lesions. DBE has a lower diagnostic rate for OGIB than for other indications. The location where a lesion is commonly found depends on the type of the lesion.

Keywords: balloon enteroscopy; double-balloon enteroscopy; small intestine.

Figure 1

Endoscopic images of double-balloon enteroscopy. Inflammatory lesions: (A) Intestinal tuberculosis on mid-jejunum, (B1,B2) Crohn’s disease with luminal narrowing on mid-ileum, balloon dilatation, (C1,C2) Crohn’s disease with capsule retention, foreign body removal, (D) Postoperative stricture mid-jejunum, (E) Ischemic enteritis on distal ileum, (F) Cryptogenic multifocal ulcerous stenosing enteritis on proximal ileum, (G) Henoch–Schönlein purpura on proximal jejunum, (H) NSAID-induced enteropathy on distal ileum. Vascular lesions: (A1–A4) Dieulafoy’s lesion on duodenal 3rd portion, epinephrine injection, argon plasma coagulation, and hemoclipping. Neoplastic lesions: (A1,A2) Malignant gastrointestinal stromal tumor on proximal jejunum, tattooing before surgery, (B) Adenocarcinoma on proximal jejunum, (C) Burkitt’s lymphoma on distal jejunum. Diverticular lesion: (A) Meckel’s diverticulum on distal ileum.