BACKGROUND Single-balloon enteroscopy(SBE)is a minimally invasive procedure to assess and treat small bowel pathologies.The most common use is to detect suspected small bowel bleeding:Insignificant gastrointestinal(GI...BACKGROUND Single-balloon enteroscopy(SBE)is a minimally invasive procedure to assess and treat small bowel pathologies.The most common use is to detect suspected small bowel bleeding:Insignificant gastrointestinal(GI)bleeding or iron deficiency anaemia(IDA).The safety and feasibility of SBE in the elderly has not been adequately studied.AIM To assess the safety and feasibility of both antegrade and retrograde SBE in elderly patients.METHODS We performed a retrospective cohort study of all antegrade and retrograde SBE done at our center from March 2011 through May 2020.We collected patient’s data including demographics,indications,findings,therapeutic interventions,and complications.The cohort was divided into 3 groups:Patients younger than 65 years(group 1),patients 65-75 years(group 2),and patients older than 75 years(group 3).We used 1-way one way analysis of variance,aχ^(2) test,and logistic regression to compare study outcomes.The primary aim was to assess diagnostic yield,therapeutic yield and rates of complications from SBE among study groups.RESULTS A total of 284 SBE were performed in 227 patients.In the 227 patients,we analyzed 194 antegrade(19 in gastric bypass patients)and 33 retrograde procedures.Mean age was 62.0(SD:16.7),130 patients were women(57.3%),98 were Hispanic(43.4%),and mean body mass index was 28(SD:6.3).The number of patients in each group were:Group 1(117,51.3%),group 2(57,25.0%)and group 3(53,23.7%).Gender,ethnicity,body mass index and proportions of antegrade and retrograde were comparable between age groups.The most common indications for procedure were:Obscure GI bleeding(48%),IDA(48%),abdominal pain(14%),and others(abnormal capsule,43%;abnormal imaging,9.7%;diarrhea 5.3%).The elderly(group 3)were more likely to have GI bleed as the indication(42.7%,40.4%,67.9%,P=0.004)without difference in IDA(44.4%,56.1%,47.2%,P=0.35).Diagnostic yield was significantly higher in the elderly group(48.2%,53.7%,68.0%),particularly in antegrade(48.5%,53.3%,72.1%,P=0.033).Angioectasias were the most common finding(21.0%)and present more often in the elderly(10.9%,20.4%,44%)(P<0.001).Therapeutic interventions were also more in the elderly group(35.0%,33.3%,58.5%,P=0.007).There were only 2(0.9%)complications,including minor oropharyngeal hemorrhage and esophageal trauma and no deaths,with no difference among groups.CONCLUSION In a retrospective analysis of SBE,we found this procedure safe and feasible in the elderly.SBE has higher diagnostic and therapeutic yields in the elderly vs the other age groups,mainly because of the increased small bowel angioectasias.展开更多
BACKGROUND Retrograde single balloon enteroscopy(SBE)is a minimally invasive procedure which is less frequently performed compared with antegrade SBE.There are few studies on the retrograde through-the-scope enterosco...BACKGROUND Retrograde single balloon enteroscopy(SBE)is a minimally invasive procedure which is less frequently performed compared with antegrade SBE.There are few studies on the retrograde through-the-scope enteroscopy(TTSE),a novel technique for evaluation of the small bowel.AIM To compare the clinical utility and safety of retrograde TTSE with retrograde SBE.METHODS Clinical data and complications of retrograde TTSE(2014-2018)and retrograde SBE(2011-2018)performed in a community hospital were reviewed and presented as mean±SD or frequency(%)and compared using proper statistical tests.Technical success was defined as insertion of the enteroscope>20 cm beyond ileocecal valve.RESULTS Data obtained from 54 retrograde SBE in 49 patients and 27 retrograde TTSE in 26 patients were studied.The most common indication for retrograde enteroscopy was iron deficiency anemia(41 patients)followed by gastrointestinal bleeding(37 patients),and chronic diarrhea(7 patients).The duration of retrograde SBE procedure(91.9±34.2 min)was significantly longer compared with retrograde TTSE(70.5±30.7 min)(P=0.04).Technical success was comparable in TTSE[23/27(85.2%)]and SBE[41/54(75.9%)(P=0.33)].The mean depth of insertion beyond the ileocecal valve in retrograde SBE(92.5±70.0 cm)tended to be longer compared with retrograde TTSE(64.6±49.0 cm)(P=0.08).No complication was observed in this study.CONCLUSION Both retrograde TTSE and retrograde SBE are feasible and safe.Retrograde TTSE takes a shorter time and has a comparable technical success with SBE.TTSE has a lower capacity of small bowel insertion.展开更多
文摘BACKGROUND Single-balloon enteroscopy(SBE)is a minimally invasive procedure to assess and treat small bowel pathologies.The most common use is to detect suspected small bowel bleeding:Insignificant gastrointestinal(GI)bleeding or iron deficiency anaemia(IDA).The safety and feasibility of SBE in the elderly has not been adequately studied.AIM To assess the safety and feasibility of both antegrade and retrograde SBE in elderly patients.METHODS We performed a retrospective cohort study of all antegrade and retrograde SBE done at our center from March 2011 through May 2020.We collected patient’s data including demographics,indications,findings,therapeutic interventions,and complications.The cohort was divided into 3 groups:Patients younger than 65 years(group 1),patients 65-75 years(group 2),and patients older than 75 years(group 3).We used 1-way one way analysis of variance,aχ^(2) test,and logistic regression to compare study outcomes.The primary aim was to assess diagnostic yield,therapeutic yield and rates of complications from SBE among study groups.RESULTS A total of 284 SBE were performed in 227 patients.In the 227 patients,we analyzed 194 antegrade(19 in gastric bypass patients)and 33 retrograde procedures.Mean age was 62.0(SD:16.7),130 patients were women(57.3%),98 were Hispanic(43.4%),and mean body mass index was 28(SD:6.3).The number of patients in each group were:Group 1(117,51.3%),group 2(57,25.0%)and group 3(53,23.7%).Gender,ethnicity,body mass index and proportions of antegrade and retrograde were comparable between age groups.The most common indications for procedure were:Obscure GI bleeding(48%),IDA(48%),abdominal pain(14%),and others(abnormal capsule,43%;abnormal imaging,9.7%;diarrhea 5.3%).The elderly(group 3)were more likely to have GI bleed as the indication(42.7%,40.4%,67.9%,P=0.004)without difference in IDA(44.4%,56.1%,47.2%,P=0.35).Diagnostic yield was significantly higher in the elderly group(48.2%,53.7%,68.0%),particularly in antegrade(48.5%,53.3%,72.1%,P=0.033).Angioectasias were the most common finding(21.0%)and present more often in the elderly(10.9%,20.4%,44%)(P<0.001).Therapeutic interventions were also more in the elderly group(35.0%,33.3%,58.5%,P=0.007).There were only 2(0.9%)complications,including minor oropharyngeal hemorrhage and esophageal trauma and no deaths,with no difference among groups.CONCLUSION In a retrospective analysis of SBE,we found this procedure safe and feasible in the elderly.SBE has higher diagnostic and therapeutic yields in the elderly vs the other age groups,mainly because of the increased small bowel angioectasias.
基金The study was approved by the Texas Tech University Health Sciences Center Institutional Review Board(Approval Number.E14078).
文摘BACKGROUND Retrograde single balloon enteroscopy(SBE)is a minimally invasive procedure which is less frequently performed compared with antegrade SBE.There are few studies on the retrograde through-the-scope enteroscopy(TTSE),a novel technique for evaluation of the small bowel.AIM To compare the clinical utility and safety of retrograde TTSE with retrograde SBE.METHODS Clinical data and complications of retrograde TTSE(2014-2018)and retrograde SBE(2011-2018)performed in a community hospital were reviewed and presented as mean±SD or frequency(%)and compared using proper statistical tests.Technical success was defined as insertion of the enteroscope>20 cm beyond ileocecal valve.RESULTS Data obtained from 54 retrograde SBE in 49 patients and 27 retrograde TTSE in 26 patients were studied.The most common indication for retrograde enteroscopy was iron deficiency anemia(41 patients)followed by gastrointestinal bleeding(37 patients),and chronic diarrhea(7 patients).The duration of retrograde SBE procedure(91.9±34.2 min)was significantly longer compared with retrograde TTSE(70.5±30.7 min)(P=0.04).Technical success was comparable in TTSE[23/27(85.2%)]and SBE[41/54(75.9%)(P=0.33)].The mean depth of insertion beyond the ileocecal valve in retrograde SBE(92.5±70.0 cm)tended to be longer compared with retrograde TTSE(64.6±49.0 cm)(P=0.08).No complication was observed in this study.CONCLUSION Both retrograde TTSE and retrograde SBE are feasible and safe.Retrograde TTSE takes a shorter time and has a comparable technical success with SBE.TTSE has a lower capacity of small bowel insertion.
