Ballonenteroskopie

Zusammenfassung

Die Ballonenteroskopie erlaubt die endoskopische Betrachtung des gesamten Dünndarms bzw. größerer Anteile davon mit der gleichzeitigen Möglichkeit der Histologiegewinnung und Durchführung therapeutischer Maßnahmen. Studien zur Doppel-Ballonenteroskopie haben die hohe diagnostische Ausbeute bei akzeptabel niedriger Komplikationsrate (etwa 1 % für die diagnostische DBE, 3–4 % für die therapeutische DBE) belegt. Die Hautpindikation ist die sogenannte mittlere GI-Blutung, d. h. die Blutungsquelle ist im Dünndarm lokalisiert. Die diagnostische Ausbeute liegt bei guter Patientenselektion bei 70–80 % und hat erheblichen Einfluss auf die weiteren therapeutischen Maßnahmen. Die Single-Ballon-Enteroskopie scheint eine Vereinfachung der Ballonenteroskopietechnik darzustellen, aber bisher sind nur wenig Originalarbeiten verfügbar, sodass die Ergebnisse prospektiver Studien und vergleichender Studien abgewartet werden muss. Derzeit muss die Doppel-Ballonenteroskopie noch als Standardverfahren für die diagnostische und therapeutische Dünndarmendoskopie angesehen werden.

Abstract

Balloon-Enteroscopy is a method allowing complete visualisation or at least large parts of the small bowel, taking biopsy samples, and endoscopic treatment in the small bowel. Studies with the Double-balloon device have demonstrated the high diagnostic value of this method combined with an acceptable low complication rate (˜ 1 % for diagnostic DBE, 3–4 % for therapeutic DBE). The major indication is the mid gastointestinal bleeding (MGI), that means that the bleeding source is located in the small bowel. The diagnostic yield in patients with MGI is between 70–80 % and influences therapeutic strategies substantially. The Single-Balloon technique seem to be easier in handling, but there are only preliminary data, therefore the results of prospective trials with a larger number of patients and comparing studies have to be awaited. Altogether actually Double-Balloon-Enteroscopy is still the standard method for diagnostic and therapeutic endoscopy of the small bowel avoiding intraoperative enteroscopy or laparotomy for therapy.

Schlüsselwörter

Doppel-Ballonenteroskopie - Single-Ballonenteroskopie - Ballonenteroskopie - Dünndarmendoskopie

Key words

double-balloon enteroscopy - single-balloon enteroscopy - balloon-guided enteroscopy - small bowel endoscopy

Literatur

• 1 May A, Nachbar L, Schneider M et al. Prospective comparison of push enteroscopy and push-and-pull enteroscopy in patients with suspected small-bowel bleeding.  Am J Gastroenterol. 2006;  100 12016-12024
• 2 May A, Pohl J, Blancas J M et al. Aktueller Stand der Doppelballonendoskopie: Konsensusbericht der 2. internationalen DBE-Konferenz 15.–16. Juni 2007 – Berlin.  Endoskopie heute. 2008;  21 52-57
• 3 Yamamoto H, Kita H, Sunada K et al. Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases.  Clin Gastroenterol Hepatol. 2004;  2 1010-1016
• 4 Tsujikawa T, Saitoh Y, Andoh A et al. Novel single-balloon enteroscopy for diagnosis and treatment of the small intestine: preliminary experiences.  Endoscopy. 2008;  40 11-15
• 5 Yamamoto H, Sekine Y, Sato Y et al. Total enteroscopy with a non surgical steerable double-balloon method.  Gastrointest Endosc. 2001;  53 216-220
• 6 May A, Nachbar L, Wardak A et al. Double-balloon enteroscopy: preliminary experience in patients with obscure gastrointestinal bleeding or chronic abdominal pain.  Endoscopy. 2003;  35 98-99
• 7 May A, Nachber L, Ell C. Push-and-Pull Enteroscopy using a single-balloon technique for difficult colonoscopy.  Endoscopy. 2006;  38 395-398
• 8 Mönkemüller K, Fry L C, Bellutti M et al. ERCP using single-balloon instead of double-balloon enteroscopy in patients with Roux-en-Y anastomosis.  Endoscopy. 2008;  , Epub
• 9 Domagk D, Bretthauer M, Lenz P et al. Carbon dioxide insufflation improves intubation depth in double-balloon enteroscopy: a randomized, controlled, double-blind trial.  Endoscopy. 2007;  39 1064-1067
• 10 Ell C, May A, Nachbar L et al. Push-and-pull enteroscopy in the small bowel using the double-balloon technique: results of a prospective European multicenter study.  Endoscopy. 2005;  37 613-616
• 11 May A, Nachbar L, Ell C. Double-balloon enteroscopy (push-and-pull-enteroscopy) of the small bowel: feasibility and diagnostic and therapeutic yield in patients with suspected small bowel disease.  Gastrointest Endosc. 2005;  62 62-70
• 12 Heine G, Hadithi M, Groenen M et al. Double balloon enteroscopy: Indications, diagnostic yield, and complications in a series of 275 patients with suspected small-bowel-diseases.  Endoscopy. 2006;  38 42-48
• 13 Mehdizadeh S, Ross A, Gerson L et al. What is the learning curve associated with double-balloon enteroscopy? Technical details and early experience in 6 U.S. tertiary care centers.  Gastrointest Endosc. 2006;  64 740-750
• 14 Sun B, Rajan E, Cheng S et al. Diagnostic yield and therapeutic impact of double-balloon enteroscopy in a large cohort of patients with obscure gastrointestinal bleeding.  Am J Gastroenterol. 2006;  101 2011-2115
• 15 Zhong J, Ma T, Zhang C et al. A retrospective study of the application on double-balloon enteroscopy in 378 patients with suspected small-bowel diseases.  Endoscopy. 2007;  39 208-215
• 16 Kawamura T, Yasuda K, Tanaka K et al. Clinical evaluation of a newly developed single-balloon enteroscope.  Gastrointest Endosc. 2008;  ,  epub
• 17 Sunada K, Yamamoto H, Kita H et al. Clinical outcomes of enteroscopy using the double-balloon method for strictures of the small intestine.  World J Gastroenterol. 2005;  11 1087-1089
• 18 May A, Nachbar L, Pohl J et al. Endoscopic interventions in the small bowel using double-balloon enteroscopy: feasibility and limitations.  Am J Gastroenterol. 2007;  102 527-535
• 19 Lee B I, Choi H, Choi K Y et al. Retrieval of a retained capsule endoscope by double-balloon enteroscopy.  Gastrointest Endosc. 2005;  62 463-465
• 20 Haruta H, Yamamoto H, Mizuta K et al. A case of successfull enteroscopic balloon dilation for late anastomotic stricture of choledochojejunostomy after living donor liver transplantation.  Liver Transpl. 2005;  11 1608-1610
• 21 Aabakken L, bretthauer M, Line P D. Double-balloon enteroscopy for endoscopic retrograde cholangiography in patients with a Roux-en-Y anastomosis.  Endoscopy. 2007;  39 1068-1071
• 22 Kuga R, Safatle-Ribeiro A V, Faintuch J et al. Endoscopic findings in the excluded stomach after Roux-en Y gastric bypass surgery.  Arch Surg. 2007;  142 942-946
• 23 Kaltenbach T, Soetikno R, Friedland S. Use of a double balloon enteroscope facilitates caecal intubation after incomplete colonoscopy with a standard colonoscope.  Dig Liver Dis. 2006;  38 921-925
• 24 Monkemueller K, Knippig C, Rickes S et al. Usefulness of the DBE in colonoscopies performed in patients with previously failed colonoscopy.  Scand J Gastroenterol. 2007;  30 277-278
• 25 Pasha S F, Harrison M E, Das A et al. Utility of double-balloon colonoscopy for completion of colon examination after incomplete colonoscopy with conventional colonoscope.  Gastrointest Endosc. 2007;  65 848-853
• 26 Ell C, May A. Mid-gastrointestinal bleeding: capsule endoscopy and push-and-pull enteroscopy give rise to a new medical term.  Endoscopy. 2006;  38 73-75
• 27 Hadithi M, Heine G D, Jacobs M A et al. A prospective study comparing video capsule endoscopy with double-balloon enteroscopy in patients with obscure gastrointestinal bleeding.  Gastroenterology. 2006;  131 327-329
• 28 Matsumoto T, Esaki M, Moriyama T et al. Comparison of capsule endoscopy and enteroscopy with the double-balloon method in patients with obscure bleeding and polyposis.  Endoscopy. 2005;  37 827-832
• 29 Nakamura M, Niwa Y, Ohmiya N et al. Preliminary comparison of capsule endoscopy and double-balloon enteroscopy in patients with suspected small-bowel bleeding.  Endoscopy. 2006;  38 59-66
• 30 Matsumoto T, Moriyama T, Esaki M et al. Performance of antegrade double-balloon enteroscopy: comparison with push enteroscopy.  Gastrointest Endosc. 2006;  62 392-398
• 31 Hayat M, Axon A T, O'Mahony S. Diagnostic yield and effect on clinical outcomes of push enteroscopy in suspected small bowel bleeding.  Endoscopy. 2000;  32 369-372
• 32 Nguyen N Q, Rayner C K, Schoeman M N. Push enteroscopy alters management in a majority of patients with obscure gastrointestinal bleeding.  J Gastroenterol Hepatol. 2005;  20 716-721
• 33 Ell C, Remke S, May A et al. The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding.  Endoscopy. 2002;  34 685-689
• 34 Plum N, May A, Manner H et al. Peutz-Jeghers syndrome: endoscopic detection and treatment of small bowel polyps by double-balloonenteroscopy.  Z Gastroenterol. 2007;  45 1049-1055
• 35 Schwarzt G D, Barkin J S. Small-bowel tumors detected by wireless capsule endoscopy.  Dig Dis Sci. 2007;  52 1026-1030
• 36 Hadithi M, Al-Toma A, Oudejans J et al. The value of double-balloon enteroscopy in patients with refractory celiac disease.  Am J Gastroenterol. 2007;  102 987-996
• 37 Mensink P, Haringsma J, Kucharzik T F et al. Complications of double balloon enteroscopy: a multicenter survey.  Endoscopy. 2007;  39 613-615
• 38 Möschler O, May A, Müller M K et al. Complications in double-balloon-enteroscopy: Results of the German DBE Register.  Z Gastroenetrol. 2008;  46 266-270