Small-bowel endoscopy

Introduction

Modern small-bowel endoscopy is performed using capsule endoscopy and balloon-assisted enteroscopy. Recently, spiral enteroscopy was added to the armamentarium of deep small-bowel endoscopy. As seen from the number of abstracts presented at this year’s Digestive Disease Week (DDW) 2009, there is ongoing clinical and research interest in the field of small-bowel endoscopy, with 130 scientific contributions this year.

This implies that small-bowel endoscopy has become a standard element of practice in endoscopy units in university hospitals and large medical centers. In addition, many community hospitals have begun to provide small-bowel endoscopy. Although issues such as costs and training remain unresolved, most expert endoscopists agree that we cannot continue to close our eyes to the large number of diseases present within the small bowel, such as nonsteroidal anti-inflammatory drug (NSAID)-induced erosions and ulcers, tumors, polyps, and inflammatory bowel disorders. For example, at present, it should be unacceptable to perform just EGD and colonoscopy in patients with obscure gastrointestinal bleeding, without considering endoscopic investigation of the small bowel. Indeed, we are learning that the small bowel is an important site of injury caused by NSAIDs, and even low dose aspirin used as a cardioprotective agent. Also, we need to move away from the idea that it is sufficient to merely visualize the small bowel using capsule endoscopy without offering therapeutic capabilities. It is imperative that enteroscopy is available on site or at a nearby center, in order to provide further diagnostic and interventional possibilities in the case of a positive capsule endoscopy.

In this review we will summarize the research in this area that was presented at DDW 2009, focusing on the use of this for the diagnosis and treatment of small-bowel disorders.

References

• 1 Morgan D, Upchurch B R, Draganov P V. et al . Spiral enteroscopy: prospective multicenter U.S. trial in patients with small bowel disorders.  Gastrointest Endosc. 2009;  69 AB128
• 2 Akerman P A, Cantero D, Pangtay J. et al . Retrograde small bowel enteroscopy using the Olympus SIF-140 260 cm enteroscope and the Vista-SB spiral overtube.  Gastrointest Endosc. 2009;  69 AB201
• 3 Akerman P A, Cantero D. Severe complications of spiral enteroscopy in the first 1750 patients.  Gastrointest Endosc. 2009;  69 AB127
• 4 Schembre D, Ross A S. Yield of double balloon versus spiral enteroscopy for obscure gastrointestinal bleeding.  Gastrointest Endosc. 2009;  69 AB193
• 5 Strobel S, Bensen S, Anderson P B. et al . The diagnostic yield of capsule endoscopy in patients with iron deficiency anemia and a negative endoscopic workup.  Gastrointest Endosc. 2009;  69 AB212
• 6 Fry L C, Mönkemüller K, Neumann H. et al . Capsule endoscopy increases the diagnostic yield of double ballon enteroscopy in patients being investigated for obscure GI bleeding (OGIB).  Gastrointest Endosc. 2009;  69 AB190
• 7 Mensink P, Godeschalk M F, Haringsma J. et al . Diagnostic and therapeutic value of balloon assisted enteroscopy in patients with suspected small bowel acute-overt GI bleeding.  Gastrointest Endosc. 2009;  69 AB202-AB203
• 8 Mönkemüller K, Fry L C, Meyer F. et al . Midgut bleeding: the concept of emergency double balloon enteroscopy (DBE).  Gastrointest Endosc. 2009;  69 AB199
• 9 Gerson L B, Newsom S, Ross A S. et al . 30-month follow-up after double balloon enteroscopy in patients with obscure gastrointestinal hemorrhage.  Gastrointest Endosc. 2009;  69 AB128
• 10 Shepela C, Wilson K. Capsule endoscopy in useful in clarifying diagnosis and guiding management when endoscopy and histology findings are discordant for the diagnosis of Crohn’s disease.  Gastrointest Endosc. 2009;  69 AB287
• 11 Petruzziello C, Naccarato P, Onati S. et al . Diagnostic role of wireless capsule endoscopy in patients with symptoms highly compatible with Crohn’s disease.  Gastroenterology. 2009;  136 A350
• 12 Wiarda B, Mensink P, Heine D. et al . Small bowel imaging comparing MR enteroclysis, capsule endoscopy and double-balloon enteroscopy in patients with (suspected) Crohn’s disease; the COMRADE study.  Gastroenterology. 2009;  136 A131
• 13 Endo H, Hosono K, Inamori M. et al . Incidence of small bowel injury induced by low-dose aspirin: a crossover study using capsule endoscopy in healthy volunteers.  Gastrointest Endosc. 2009;  69 AB211
• 14 Lee T H, Kim J O, Kim W J. et al . An endoscopic analysis of ulcers of small intestine detected by double balloon enteroscopy.  Gastrointest Endosc. 2009;  69 AB203
• 15 Fujimori S, Gudis K, Takahashi Y. et al . Distribution of small intestinal mucosal injuries with short-term administration of non-steroidal anti-inflammatory drugs.  Gastrointest Endosc. 2009;  69 AB100
• 16 Fujimori S, Seo T, Takahashi Y. et al . Rebamipide prevents NSAID-induced small intestinal injury: a prospective, double-blind, randomized controlled trial using capsule endoscopy.  Gastroenterology. 2009;  136 A135-136
• 17 Watanabe T, Nagami Y, Sugimori S. et al . NSAID induced small bowel injury is reduced in patients with rheumatoid arthritis receiving anti-tumor necrosis factor-therapy.  Gastroenterology. 2009;  136 A715
• 18 Yadav A, Decker G A, Crowell M D. et al . Learning curve for double balloon enteroscopy (DBE).  Gastrointest Endosc. 2009;  69 AB191
• 19 Ohtsuka K, Kashida H, Ikeda H. et al . The usefulness of carbon dioxide insufflations for single balloon panenteroscopy.  Gastrointest Endosc. 2009;  69 AB192
• 20 Aktas H, Mensink P, Haringsma J. et al . Single balloon enteroscopy: low incidence of procedure related hyperamylasemia and complications.  Gastrointest Endosc. 2009;  69 AB197
• 21 Thosami N, Jafri S MR, Dekovich A A. et al . Capsule endoscopy in patients with low neutrophil count and evidence of gastrointestinal bleeding.  Gastrointest Endosc. 2009;  69 AB199
• 22 Lee K J, Kim Y i. Long-term follow-up of patients with spontaneously stopped obscure overt gastrointestinal bleeding after capsule endoscopy.  Gastrointest Endosc. 2009;  69 AB201
• 23 Laine L A, Sahota A, Shah A. Does capsule endoscopy improve outcomes in obscure GI bleeding: randomized controlled trial of capsule endoscopy vs dedicated small bowel radiography.  Gastrointest Endosc. 2009;  69 AB99
• 24 Ueda M, Kameda N, Fujiwara Y. et al . Small intestinal vascular lesions in patients with obscure gastrointestinal bleeding: clinical characteristics and efficacy of endoscopic treatment.  Gastrointest Endosc. 2009;  69 AB205
• 25 Leighton J, Gralnek I M, Richner R E. et al . Capsule endoscopy in ”suspected“ small bowel Crohn’s disease: economic impact of disease, diagnosis and treatment.  Gastroenterology. 2009;  136 A650
• 26 Watanabe K, Sogawa M, Hosomi S. et al . The efficacy of retrograde deep insertion of single balloon endoscopy for patients with Crohn’s disease at times of conventional colonoscopy on outpatients: prospective, open-label, feasibility study.  Gastrointest Endosc. 2009;  69 AB216-AB217
• 27 Bellutti M, Mönkemüller K, Fry L C. et al . How often is Crohn’s disease the culprit of perianal fistulas?.  Gastroenterology. 2009;  136 178
• 28 Kopacova M, Tachecí I, Rejchrt S. et al . The role of double balloon enteroscopy in the diagnosis of small intestinal tumours.  Gastrointest Endosc. 2009;  69 AB204
• 29 Nakamura M, Ohmiya N, Shirai O. et al . Diagnosis and evaluation of therapeutic effect for B cell lymphoma with small bowel involvement by using video capsule endoscopy and double balloon endoscopy.  Gastrointest Endosc. 2009;  69 AB198
• 30 Fry L C, Neumann H, Rickes S. et al . Malignant small bowel tumours in patients undergoing double-balloon enteroscopy (DBE) for obscure gastrointestinal bleeding (OGIB).  Gastroenterology. 2009;  136 A214
• 31 Nakatani M, Fujiwara Y, Ueda M. et al . Diagnosis of gastrointestinal stromal tumors by double- balloon enteroscopy.  Gastrointest Endosc. 2009;  69 AB198
• 32 Malagelada C, DeIorio F, Azpiroz F. et al . Functional disorders of disordered function? Intestinal dismotility evidenced by an original technique.  Gastroenterology. 2009;  136 A225
• 33 Dassopoulos T, Kumar R, Bejakovic S. et al . Computer vision based automated statistical analysis and assessment of Crohn’s disease lesions in wireless capsule endoscopy images.  Gastroenterology. 2009;  136 A649
• 34 Ng E K, Chiu P W, Wong S K. et al . A specially designed 24-hours capsule endoscope for monitoring of peptic ulcer rebleeding from animal research to clinical study.  Gastrointest Endosc. 2009;  69 AB183
• 35 Triantafyllou K, Papanilolaou I S, Papaxoinis K. et al . Can two cameras detect more lesions in the small bowel than one? A small bowel capsule endoscopy feasibility trial with PillCam Colon.  Gastroenterology. 2009;  136 A649
• 36 Van Weyenberg S J, Van Turenhout S T, Bouma G. et al . Risk of video capsule endoscopy retention and the use of double balloon endoscopy as the primary method for video capsule endoscope retrieval.  Gastrointest Endosc. 2009;  69 AB199
• 37 Despott E J, Tripoli E, Konieczko K. et al . Dilatation of small bowel strictures by double balloon enteroscopy: further results from the UK.  Gastrointest Endosc. 2009;  69 AB188
• 38 Efthymiou M, Taylor A, Desmond P. Single balloon enteroscopy versus double balloon enteroscopy, preliminary results of a randomized controlled trial.  Gastrointest Endosc. 2009;  69 AB195
• 39 Decker G A, Crowell M D, Das A. et al . Predictors of insertion depth at double balloon enteroscopy (DBE).  Gastrointest Endosc. 2009;  69 AB309-AB310
• 40 Wang A Y, Sauer B, Behm B W. et al . Single-balloon enteroscopy effectively enables diagnostic and therapeutic retrograde cholangiography in patients with surgically altered anatomy.  Gastrointest Endosc. 2009;  69 AB152-AB153
• 41 Ichikawa S, Hiraoka A, Hasebe A. et al . Invention for therapeutic ERCP with single balloon enteroscopy for CBD stone following Roux-en Y biliary reconstruction.  Gastrointest Endosc. 2009;  69 AB157
• 42 Mönkemüller K, Fry L C, Neumann H. et al . Single balloon enteroscopy (SBE) versus double balloon (DBE) ERCP in patients with Roux-en-Y anastomosis.  Gastrointest Endosc. 2009;  69 AB139
• 43 Takenaka H, Ohmiya N, Nakamura M. et al . Diagnosis of protein-losing gastroenteropathy by using double balloon enteroscopy and videocapsule endoscopy.  Gastrointest Endosc. 2009;  69 AB195
• 44 Moreels T G, Mensink P, Kuipers E J. et al . Small bowel evaluation by double-balloon enteroscopy in pediatric patients: results of two university hospital endoscopy units.  Gastrointest Endosc. 2009;  69 AB172