Reply to T. Kav et al.

We would like to thank Dr. Kav and colleagues for their comments on our article [1] regarding the insertion technique for single-balloon enteroscopy (SBE).

Kav et al. used maximum suction power instead of the hook shape of the scope tip to hold the small intestine. They conclude that the power suction maneuver is safe and strong enough to grip the intestine without causing more harm than the rigid tip of the hook-shaped scope. They also feel that the suction technique gives them a little bit more examination depth and ease of insertion for the same duration of procedure compared to their former experiences.

Basically, we agree with the suction technique to hold the small intestine. However, we want to emphasize that the most harm to the small-intestinal mucosa is caused not by the hook shape of the endoscope’s tip, but by forcible insertion of the overtube. We have examined more than 120 cases of SBE performed over 2 years and found only one case, in a patient with Crohn’s disease, of mucosal laceration due to rigidity of the endoscope’s tip. On the other hand, five patients suffered mucosal injury during overtube insertion at the site of an adhesion or intestinal narrowing.

Although we did not describe it in our manuscript, we sometimes used the assistance of suction power when the hook shape was not enough to hold the small intestine. In our experience, suction power by itself is not enough to hold the small intestine. We therefore suggest that the endoscopist using SBE may choose either the suction technique or the hook-shape technique or both to hold the small intestine for a safe and smooth insertion. We would also expect the suction technique to be useful for reaching deeper portions than the hook shape, because this method is theoretically similar to the scope balloon in double-balloon enteroscopy [2]. It seems to be necessary now to determine the optimal suction power for safe and efficient scope insertion in SBE.

Competing interests: None

References

• 1 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
• 2 Yamamoto H, Seike Y, Sato Y. et al . Total enteroscopy with a nonsurgical steerable double-balloon method.  Gastrointest Endosc. 2001;  53 216-220