Double-balloon endoscopy for the diagnosis and treatment of small intestinal disease: initial experience in 21 patients

Aim: Until recently, only the proximal small bowel was accessible for diagnostic and therapeutic endoscopy. Endoscopic evaluation of this organ has often required open laparotomy with surgically assisted passage of the endoscope through the intestine. Recently, Yamamoto et al have developed a new method, double-balloon endoscopy (DBE) that allows high-resolution visualization, biopsies, and therapeutic interventions in all segments of the GI tract. Our aim was to report our early experience with the Fujinon EN-450 T5 therapeutic double-balloon endoscope.

Methods: Between August 2005 and February 2006, 23 DBE was conducted in 21 consecutive patients (M/F: 12/9, age: 54.1±11.7 years) presenting at our tertiary referral hospitals (15 and 4 patients from the oral or the anal route, respectively; 2 patients from both). All procedures were done by i.v. anesthesia, at our outpatient clinic. After the procedure, the patients were monitored in a recovery room for at least 4h before discharge.

Results: The main indication for DBE was suspected small-bowel GI bleeding (13), diagnosis or complications of IBD (4), polyposis syndrome (3), stenosis and suspected small bowel tumor (1–1) and insertion of jejunal catheter in one case. Ten out of 20 patients (50%) had a small-bowel finding, with 14 of 20 (70%) of the patients having a more accurate diagnostic input. The average insertion length was app. 140cm (range 50–350cm, SD 85). Patients' tolerance of the procedure was excellent. No severe complications were recognized.

Conclusions: Based on our limited experience double-balloon enteroscopy is a safe and useful method of evaluating and treating small bowel disease in selected patients, including in patients with suspected small-bowel strictures, in whom capsule endoscopy is contraindicated.