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Saturday, June 30, 2007

Is double-balloon enteroscopy an accurate method to diagnose small-bowel disorders?

Is double-balloon enteroscopy an accurate method to diagnose small-bowel disorders?

Surg Endosc. 2007 Jun 26

Safatle-Ribeiro AV, Kuga R, Ishida R, Furuya C, Ribeiro U, Cecconello I, Ishioka S, Sakai P. Gastroenterology, University of São Paulo, São Paulo, SP, Brazil,

Keywords: Enteroscopy - Double-balloon enteroscopy - Small intestine endoscopy

BACKGROUND AND STUDY AIMS: The aim of this study was to analyze the contribution of the double-balloon enteroscopy (DBE) for diagnosis of the small bowel disorders.

PATIENTS AND METHODS: Forty-four patients (20 women, 24 men; mean age 53.5 years-old, range 21-89 years) with chronic gastrointestinal bleeding, diarrhea, polyposis, weight-loss, Roux-en-Y surgery, and other indications underwent DBE.

RESULTS: Twenty patients had occult or obscure gastrointestinal bleeding. The source of bleeding was identified in 15/20 (75%): multiple angiodysplasias in four, arterial-venous malformation beyond the ligament of Treitz in two that could be treated with injection successfully. Other diagnoses included: duodenal adenocarcinoma, jejunal tuberculosis, erosions and ulcer of the jejunum. Of 24 patients with other indications, the diagnosis could be achieved in 18 of them (75%), including: two lymphomas, plasmocytoma, Gardner's syndrome, Peutz-Jeghers' syndrome, familial adenomatous polyposis, Behçet's disease, jejunal submucosal lesion, lymphangiectasia due to blastomycosis and unspecific chronic jejunitis. Of three cases with Roux-en-Y reconstruction, two underwent DBE in order to perform biopsies of the excluded duodenum. Additionally, two patients underwent DBE to exclude Crohn's disease and lymphoma of the small bowel. The mean length of small bowel examination was 240 +/- 50 cm during a single approach. The diagnostic yield was 75% (33/44 cases) and therapeutic yield was 63.6%. No major complications were observed, only minor complication such as sore throat in 4/44 (9.1%).

CONCLUSIONS: 1. DBE is a safe and and accurate method to diagnose small bowel disorders; 2. this method permits chromoscopy, biopsies and treatment of the lesions.

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