BACKGROUND Performing endoscopic retrograde cholangiopancreatography(ERCP)in pati-ents with surgically altered gastrointestinal anatomy poses significant challenges.Double-balloon enteroscopy-assisted ERCP(DBE-ERCP)ha...BACKGROUND Performing endoscopic retrograde cholangiopancreatography(ERCP)in pati-ents with surgically altered gastrointestinal anatomy poses significant challenges.Double-balloon enteroscopy-assisted ERCP(DBE-ERCP)has emerged as a safe and effective approach in this patient population.This study aims to provide an updated systematic review and meta-analysis of the safety and efficacy of DBEERCP in patients with surgically altered anatomy(SAA),building on previously published evidence.AIM To evaluate the safety and efficacy of DBE-ERCP in patients with SAA through an updated systematic review and meta-analysis and to compare outcomes between short-and long-scope double-balloon enteroscopy(DBE).METHODS A comprehensive search of PubMed,EMBASE,and Web of Science was performed for studies published up to March 2025 investigating DBE-ERCP in patients with surgically altered gastrointestinal anatomy.A random-effects model was applied to conduct a meta-analysis of proportions.The risk of bias was evaluated using the Newcastle-Ottawa Scale and the Joanna Briggs Institute Scale.Heterogeneity was evaluated using the inconsistency statistic(I2).Publication bias was examined using funnel plots and Egger’s regression test.RESULTS A total of 40 studies were included,comprising 10 cohort studies and 30 case series,including 2689 patients who underwent 3478 procedures.The surgical procedures were primarily classified into three categories:Roux-en-Y reconstruction(including hepaticojejunostomy,gastric bypass,and choledochojejunostomy,etc.)in 1156 cases;pancreaticoduodenectomy(performed using either the Whipple or Child technique)in 549 cases;and Billroth II anastomosis in 265 cases.The combined success rate for reaching the papilla was 92%(95%CI:89%-95%).The overall enteroscopy success rate was 89%(95%CI:85%-92%).The pooled diagnostic success rate was 90%(95%CI:85%-95%),while the therapeutic success rate reached 92%(95%CI:89%-95%).Adverse events reported in 5.7%of patients(95%CI:4.1%-7.5%).Subgroup analysis comparing short-scope and long-scope demonstrated that the short DBE was superior in terms of papilla reached rate,enteroscopy success,and procedural success.No significant differences were observed between groups in diagnostic success or adverse events.CONCLUSION DBE-ERCP demonstrates both safety and efficacy in patients with SAA.Compared to long-scope DBE,short-scope DBE shows greater clinical promise;however,further randomized controlled trials are warranted to validate these findings.展开更多
BACKGROUND In postsurgical upper gastrointestinal anatomy,motorized spiral enteroscopy(MSE)assisted endoscopic retrograde cholangiopancreaticography(ERCP)was shown feasible and has the advantage that standard ERCP ins...BACKGROUND In postsurgical upper gastrointestinal anatomy,motorized spiral enteroscopy(MSE)assisted endoscopic retrograde cholangiopancreaticography(ERCP)was shown feasible and has the advantage that standard ERCP instruments can be used.Therefore,MSE-ERCP appears to be the optimal solution for postsurgical patients,especially with Roux-en-Y anatomy.AIM To show feasibility and safety of MSE-ERCP in patients with Roux-en-Y anatomy.METHODS We retrospectively analyzed all consecutive MSE-ERCP procedures in patients with Roux-en-Y anatomy between September 2021 and May 2023 in an endoscopic tertiary referral center.RESULTS We identified 26 MSE-ERCPs:(1)18 MSE-ERCPs in 13 patients with Roux-en-Y anatomy after liver transplantation(n=11)or gastrectomy(n=2);and(2)Another 8 MSE-ERCP interventions in 5 patients with very long Roux-en-Y situation after gastric bypass.Overall success of reaching the biliary entry was 88%and further interventions were successful in 83%of patients.In very long alimentary limb situations,success of reaching the biliary entry was not-significantly lower compared to“standard”Roux-en-Y(75%vs 94%,P=0.215).ERCP-interventions were not-significantly less successful in patients with native papilla compared to hepaticojejunostomy(63%vs 93%,P=0.103).Mean intervention time was 105 minutes.Intervention times were longer in very long limb situations(133 minutes vs 91 minutes;P=0.032).Overall,we observed three adverse events(n=1 caused by enteroscopy,n=1 caused by the biliary intervention,n=1 unrelated to the procedure).In 15/26 cases(58%)MSE-ERCP was carried out on an outpatient basis.CONCLUSION MSE-ERCP has been a promising technique for patients with Roux-en-Y reconstruction requiring biliary interventions.However,MSE was recently withdrawn from the market due to severe safety concerns,which were not observed in this study.展开更多
BACKGROUND Single-balloon enteroscopy(SBE)is an established procedure for evaluating small bowel lesions.While its efficacy is well recognized,the incidence of major complications and their associated risk factors in ...BACKGROUND Single-balloon enteroscopy(SBE)is an established procedure for evaluating small bowel lesions.While its efficacy is well recognized,the incidence of major complications and their associated risk factors in a large population remain unclear.AIM To investigate the complications and risk factors associated with diagnostic SBE.METHODS This multicenter retrospective study included consecutive patients who underwent diagnostic SBE at three tertiary care hospitals between January 2016 and September 2024.Data on baseline characteristics,procedural parameters,indications,findings,and major complications were collected and analyzed.RESULTS A total of 2865 SBE procedures were performed in 1840 patients.The mean age was 51±18 years,and 64.5%were male.The most common indication was obscure gastrointestinal bleeding(57.1%),followed by abdominal pain(30.5%).The major complication rate was 0.4%(7/1840),all of which involved acute intestinal perforation identified during the procedure.Among the perforation cases,6 occurred in patients undergoing SBE for abdominal pain and 1 for obscure gastrointestinal bleeding.The perforation sites included the ileum(6/7)and duodenum(1/7).All cases were successfully managed surgically.Previous abdominal surgery and the use of abdominal compression were significantly associated with an increased risk of perforation(P value<0.001 for both).In subgroup analysis,perforation rates were 2.1%(6/288)in patients with prior abdominal surgery and 1.6%(7/428)with abdominal compression.CONCLUSION Acute intestinal perforation is a rare but serious complication.Prior abdominal surgery and abdominal compression are important risk factors,and careful patient selection is recommended to minimize complications.展开更多
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
Performing endoscopic retrograde cholangiopancreatography (ERCP) in patientswith Roux-en-Y-anatomy is technically challenging and additional techniquesincluding balloon-assisted enteroscopy, endoscopic ultrasound (EUS...Performing endoscopic retrograde cholangiopancreatography (ERCP) in patientswith Roux-en-Y-anatomy is technically challenging and additional techniquesincluding balloon-assisted enteroscopy, endoscopic ultrasound (EUS) guided, andpercutaneous approaches offers only modest success rates. Motorized spiralenteroscopy (MSE)-assisted ERCP (MSE-ERCP) has emerged as a potentialalternative. In a retrospective study by Nennstiel et al, MSE-ERCP achieved highsuccess rates for biliary entry (88%) and therapeutic intervention (83%). However,outcomes varied significantly between bilioenteric anastomosis (93%) and nativepapilla (63%), underscoring the importance of anatomy-driven proceduralselection. Despite encouraging efficacy, the global withdrawal of the MSE platformdue to serious device-related complications highlights the ongoing balancebetween feasibility and safety. Future directions should prioritize refinements indevice engineering, multicenter prospective trials comparing MSE with balloonassistedand EUS-guided techniques, and systematic outcome stratification byanatomical subgroup. Such efforts will be critical to defining the role of MSEwithin the therapeutic algorithm for surgically altered anatomy.展开更多
BACKGROUND Small-bowel disorders,including obscure gastrointestinal bleeding(OGIB),Crohn's disease,and tumors,require accurate diagnostic approaches for effective treatment.Video capsule endoscopy(VCE)and simple b...BACKGROUND Small-bowel disorders,including obscure gastrointestinal bleeding(OGIB),Crohn's disease,and tumors,require accurate diagnostic approaches for effective treatment.Video capsule endoscopy(VCE)and simple balloon enteroscopy(SBE)are widely used;however,each modality has limitations,particularly regarding therapeutic intervention and diagnostic yield.AIM To evaluate diagnostic yields of various modalities for small bowel bleeding,analyze factors affecting heterogeneity,and improve understanding of clinical outcomes associated with different diagnostic approaches.METHODS A comprehensive search of four databases(PubMed,Embase,Cochrane Library,and Scopus)revealed over 600 citations related to the use of capsule endoscopy and balloon enteroscopy for diagnosing small intestine disorders with wall thickening.Based on predetermined eligibility criteria,seven moderateto-high-quality retrospective studies were analyzed to evaluate the diagnostic performance of VCE and SBE in patients with small bowel disorders.Quality Assessment of Diagnostic Accuracy Studies was applied to evaluate the risk of bias and overall methodological quality.RESULTS Analysis of seven moderate-to-high-quality retrospective studies revealed comparable overall detection rates for small bowel lesions between VCE and SBE.VCE demonstrated superior performance in detecting vascular lesions.Conversely,SBE exhibited a higher efficacy in detecting ulcerative lesions.The overall diagnostic yield varied across studies,with VCE showing a range of 32%–83%for small bowel bleeding,whereas SBE demonstrated a higher overall detection rate of 69.7%compared to 57.6%for VCE(P<0.05).Notably,SBE showed superior performance in diagnosing Crohn's disease,with a detection rate of 35%,compared to 11.3%for VCE(P<0.001).The diagnostic concordance between VCE and SBE was influenced by the lesion type.Strong agreement was observed for inflammatory lesions(κ=0.82,95%CI:0.75-0.89),whereas moderate agreement was noted for tumors(κ=0.61,95%CI:0.52-0.70)and angiectasias(κ=0.58,95%CI:0.49-0.67).SBE demonstrated significant advantages in therapeutic interventions,particularly in overt bleeding.Patient tolerability was generally higher for VCE,with a completion rate of 95%(95%CI:92%-98%),compared to 85%for SBE(95%CI:80%-90%).However,the capsule retention rate for VCE was 1.4%(95%CI:0.8%-2.0%),necessitating subsequent intervention.CONCLUSION VCE and SBE are complementary techniques for evaluating small intestinal disorders.Although VCE remains the initial test of choice for patients with stable OGIB,SBE should be considered in patients requiring therapeutic intervention.Thus,combining both modalities enhances diagnostic accuracy and patient management.展开更多
With the continuous advancement in medical technology,endoscopy has gained significant attention as a crucial diagnostic tool.The introduction of motorized spiral enteroscopy(MSE)represents a significant advancement i...With the continuous advancement in medical technology,endoscopy has gained significant attention as a crucial diagnostic tool.The introduction of motorized spiral enteroscopy(MSE)represents a significant advancement in the diagnosis and treatment of small bowel diseases.While there are safety concerns and a high reliance on the operator’s skills,MSE should not be disregarded entirely.Instead,it should be considered as a supplementary endoscopic technique,particularly in situations where conventional endoscopy proves ineffective.Through continuous research and technical optimization,MSE has the potential to become an im-portant addition to the endoscopy toolbox in the future.We call on colleagues in the industry to work together to promote the improvement of MSE technology through continuous research and practice,with the aim to bring out its unique value in endoscopy while ensuring patient safety.展开更多
Motorized spiral enteroscopy(MSE)is the latest advance in device-assisted enteroscopy.Adverse events related to MSE were discussed in a recent large systematic review and meta-analysis and were directly compared with ...Motorized spiral enteroscopy(MSE)is the latest advance in device-assisted enteroscopy.Adverse events related to MSE were discussed in a recent large systematic review and meta-analysis and were directly compared with those of balloon enteroscopy in a case-matched study and a randomized controlled trial.Following the real-life application of MSE,an unexpected safety issue emerged regarding esophageal injury and the technique has been withdrawn from the global market,despite encouraging results in terms of diagnostic and therapeutic yield.We conducted an Italian multicenter real-life prospective study,which was prematurely terminated after the withdrawal of MSE from the market.The primary goals were the evaluation of MSE performance(both diagnostic and therapeutic)and its safety in routine endoscopic practice,particularly in the early phase of introduction in the endoscopic unit.A subanalysis,which involved patients who underwent MSE after unsuccessful balloon enteroscopy,demonstrated,for the first time,the promising performance of MSE as a rescue procedure.Given its remarkable performance in clinical practice and its potential role as a backup technique following a previously failed enteroscopy,it may be more appropriate to refine and enhance MSE in the future rather than completely abandoning it.展开更多
Background: Endoscopic treatment of biliopancreatic pathology is challenging due to surgically altered anatomy after Whipple's pancreaticoduodenectomy. This study aimed to evaluate the feasibility and safety of si...Background: Endoscopic treatment of biliopancreatic pathology is challenging due to surgically altered anatomy after Whipple's pancreaticoduodenectomy. This study aimed to evaluate the feasibility and safety of single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography(SBE-ERCP) to treat biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants. Methods: We retrospectively analyzed 106 SBE-ERCP procedures in 46 patients with Whipple's variants. Technical and clinical success rates and adverse events were evaluated. Results: Biliary SBE-ERCP was performed in 34 patients and pancreatic SBE-ERCP in 17, including 5 with both indications. From a total of 106 SBE-ERCP procedures, 76 were biliary indication with technical success rate of 68/76(90%) procedures and clinical success rate of 30/34(88%) patients. Mild adverse event rate was 8/76(11%), without serious adverse events. From a total of 106 SBE-ERCP procedures, 30 were pancreatic indication with technical success rate of 24/30(80%) procedures( P = 0.194 vs. biliary SBEERCP) and clinical success rate of 11/17(65%) patients( P = 0.016 vs. biliary SBE-ERCP). Mild adverse event rate was 6/30(20%)( P = 0.194 vs. biliary SBE-ERCP), without serious adverse events. After SBE-ERCP failure, endoscopic ultrasound-guided drainage, percutaneous drainage and redo surgery were alternative therapeutic options. Conclusions: Biliopancreatic pathology after Whipple's pancreaticoduodenectomy variants can be treated using SBE-ERCP without serious adverse events. Technical and clinical success rates are high for biliary indications, whereas clinical success rate of pancreatic indications is significantly lower. SBE-ERCP can be considered as first-line treatment option in this patient group with surgically altered anatomy.展开更多
The diagnosis and opportunity for endoscopic therapy of gastric or duodenal lesions may be missed at esophagogastroduodenoscopy(EGD) because of technical difficulty in intubating at EGD the postoperatively excluded st...The diagnosis and opportunity for endoscopic therapy of gastric or duodenal lesions may be missed at esophagogastroduodenoscopy(EGD) because of technical difficulty in intubating at EGD the postoperatively excluded stomach and proximal duodenum in patients status post Roux-en-Y gastric bypass(RYGB). Two cases are reported of acute upper gastrointestinal bleeding 10 or 11 years status postRYGB, performed for morbid obesity, in which the EGD was non-diagnostic due to failure to intubate the excluded stomach and proximal duodenum, whereas subsequent push enteroscopy or single balloon enteroscopy were diagnostic and revealed 4-cm-wide or 5-mm-wide bulbar ulcers and even permitted application of endoscopic therapy. These case reports suggest consideration of push enteroscopy, or single balloon enteroscopy, where available, in the endoscopic evaluation of acute UGI bleeding in patients status post RYGB surgery when the EGD was non-diagnostic because of failure to intubate these excluded segments.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
Celiac disease （CD） is an autoimmune inflammatory disease of the small intestine as a result of reaction to wheat protein, gluten. Exclusion of dietary gluten is the mainstay of the treatment that necessitates a pre...Celiac disease （CD） is an autoimmune inflammatory disease of the small intestine as a result of reaction to wheat protein, gluten. Exclusion of dietary gluten is the mainstay of the treatment that necessitates a precise diagnosis of the disease. Serological screen ing may aid in identifying patients with suspected CD, which should be confirmed by intestinal biopsy. It has been shown that duodenal biopsies are good for de- tection of the disease in most patients. However, there is a group of patients with positive serology and incon- clusive pathology. As a result of the widespread use of serology, many patients with equivocal findings grow quickly. Unfortunately current endoscopic methods can only diagnose villous atrophy, which can be present in the later grades of disease （i.e., Marsh m）. To diag- nose CD correctly, going deeper in the intestine may be necessary. Enteroscopy can reveal changes in CD in the intestinal mucosa in 10%-17% of cases that have negative histology at initial workup. Invasiveness of the method limits its use. Capsule endoscopy may be a good substitute for enteroscopy. However, both tech- niques should be reserved for patients with suspected diagnosis of complications. This paper reviews the cur- rent literature in terms of the value of enteroscopy for diagnosis of CD.展开更多
AIM To evaluate the therapeutic role of double-balloon enteroscopy(DBE) in small bowel strictures and to propose a standard approach to small bowel strictures.METHODS Systematic review of studies involving DBE in pati...AIM To evaluate the therapeutic role of double-balloon enteroscopy(DBE) in small bowel strictures and to propose a standard approach to small bowel strictures.METHODS Systematic review of studies involving DBE in patients with small bowel strictures. Only studies limited to small bowel strictures were included and those with ileo-colonic strictures were excluded. RESULTS In total 13 studies were included,in which 310 patients were dilated. The average follow-up time was 31.8 mo per patient. The complication rate was 4.8% per patient and 2.6% per dilatation. Surgery was avoided in 80% of patients. After the first dilatation,46% were treated with re-dilatation and only 17% required surgery.CONCLUSION DBE-assisted dilatation avoids surgery in 80% of patients with small bowel strictures and is safe and effective. We propose a standardized approach to small bowel strictures.展开更多
Small bowel tumors(SBTs)have been increasingly diagnosed in recent decades.The pathogenesis of this increment is largely unknown,but advances in radiological and endoscopic methods facilitate the improvement of the di...Small bowel tumors(SBTs)have been increasingly diagnosed in recent decades.The pathogenesis of this increment is largely unknown,but advances in radiological and endoscopic methods facilitate the improvement of the diagnosis.Capsule endoscopy(CE)and device-assisted enteroscopy(DAE)allow the clinician to assess the entire small bowel in the search for suspicious lesions,or a cause of symptoms.In this review,we discuss the role of enteroscopy,techniques and strategies in the diagnosis and management of SBTs,and a brief description of the most common tumors.展开更多
Since its introduction in 2001 capsule endoscopy opened up the small bowel for diagnostic approaches followed by double balloon enteroscopy which enabled the endoscopic community to perform therapeutic interventions i...Since its introduction in 2001 capsule endoscopy opened up the small bowel for diagnostic approaches followed by double balloon enteroscopy which enabled the endoscopic community to perform therapeutic interventions in the whole small intestine.In this review the scientific developments related to indications,diagnostic yield and complications of the last years between the competing devices double ballon enteroscopy,single balloon enteroscopy and spiral enteroscopy are illustrated.展开更多
Objective:To investigate the feasibility and safety of achieving total enteroscopy by consecutive bidirectional double-balloon enteroscopy(DBE)procedures.Methods:The demographic data,indication,initial insertion route...Objective:To investigate the feasibility and safety of achieving total enteroscopy by consecutive bidirectional double-balloon enteroscopy(DBE)procedures.Methods:The demographic data,indication,initial insertion route,examination time for each insertion and the entire procedure,total enteroscopy rate,diagnostic yield and adverse events of patients who attempted to achieve total enteroscopy by consecutive bidirectional DBE procedures from January 2014 to December 2019 were retrospectively analyzed.展开更多
Inflammatory bowel disease(IBD)includes Crohn’s disease(CD),ulcerative colitis and unclassified entities.CD commonly involves the terminal ileum and colon but at the time of diagnosis it can be confined to the small ...Inflammatory bowel disease(IBD)includes Crohn’s disease(CD),ulcerative colitis and unclassified entities.CD commonly involves the terminal ileum and colon but at the time of diagnosis it can be confined to the small bowel(SB)in about 30%of the patients,especially in the young ones.Management of isolated SB-CD can be challenging and objective evaluation of the SB mucosa is essential in differentiating CD from other enteropathies to achieve therapeutic decisions and to plan the follow-up.The introduction of cross-sectional imaging techniques and capsule endoscopy(CE)have significantly expanded the ability to diagnose SB diseases providing a non-invasive test for the visualization of the entire SB mucosa.The main CE limitations are the low specificity,the lack of therapeutic capabilities and the impossibility to take biopsies.Device assisted enteroscopy(DAE)enables histological confirmation when traditional endoscopy,capsule endoscopy and cross-sectional imaging are inconclusive and also allows therapeutic interventions such as balloon stricture dilation,intralesional steroid injection,capsule retrieval and more recently stent insertion.In the current review we will discuss technical aspect,indications and safety profile of DAE in children and adults with IBD.展开更多
The single-balloon enteroscopy(SBE) system was launched in 2007, proposed as a simpler method than double-balloon enteroscopy(DBE). Controversy surrounds whether the SBE system has the same insertability as DBE. Howev...The single-balloon enteroscopy(SBE) system was launched in 2007, proposed as a simpler method than double-balloon enteroscopy(DBE). Controversy surrounds whether the SBE system has the same insertability as DBE. However, many methods have been proposed to improve the depth of insertion with the SBE system, involving several techniques and endoscopic accessories. SBE is used for investigating not only small bowel diseases, but also diseases of the pancreatobiliary and colonic structures. SBE is a necessary advancement for many endoscopic procedures and applications in modern clinical practice. In our review, we summarized the current literature concerning the insertability of SBE and described the technical aspects of improving the rate of deep insertion in SBE procedures. In addition, the recent applications of SBE to diseases besides those of the small bowel are described.展开更多
BACKGROUND Obscure gastrointestinal(GI)bleeding is defined as persistent bleeding despite negative evaluation with both esophagogastroduodenoscopy and colonoscopy and can be secondary to small intestinal pathology.Sta...BACKGROUND Obscure gastrointestinal(GI)bleeding is defined as persistent bleeding despite negative evaluation with both esophagogastroduodenoscopy and colonoscopy and can be secondary to small intestinal pathology.Standard endoscopy as well as push endoscopy can be a challenge in those with altered anatomy given inaccessible areas as well as perforation risk.Single and double balloon enteroscopy can be warranted in this patient population in instances of obscure GI bleed.AIM To assess the safety and diagnostic efficacy of balloon enteroscopy for obscure GI bleeding in patients with surgically altered anatomy.METHODS A search was conducted through PubMed,MEDLINE,Google Scholar,Scopus,and Embase with the key words“enteroscopy,”“obscure bleeding,”and“altered anatomy,”to identify relevant articles in English with no restricted time frame.A search within the Reference Citation Analysis database was conducted to ensure inclusion of the latest high impact articles.Study types included in the review were prospective and retrospective reviews,case series,and case reports.The reference lists of these papers were also reviewed to find further papers that were applicable.The authors extracted the data from the studies that fit inclusion criteria.Data of interest included type of study,type of procedure,and type of altered anatomy,as well as the number of patients with any diagnostic or therapeutic intervention.Data was also recorded on procedure tolerance and complications.The data was analyzed with descriptive statistics.RESULTS Our literature search yielded 14 studies that were included.There were 68 procedures performed with 61 unique patients subjected to these procedures.Forty-four(65%)of the procedures were double balloon,21(31%)were single balloon,and 3(4%)were classified as through the scope balloon assisted.The most common altered anatomy types included Gastric Bypass Roux-en-Y,Pylorus Sparing Whipple,Orthotopic Liver Transplantation with Roux-en-Y,and Gastrojejunostomy Roux-en-Y.The procedures were successfully performed in each patient.There were 5(7%)procedures that were complicated by perforation.Amongst the available data,the diagnostic yield was 48/59(81%)and a therapeutic yield of 39/59(66%).One patient was recommended surgical revision of their altered anatomy following enteroscopy.CONCLUSION Balloon enteroscopy is a useful diagnostic modality in investigating obscure GI bleeding within those with surgically altered anatomy;however,precautions must be taken as this population may have increased perforation risk.展开更多
BACKGROUND Single balloon enteroscopy(SBE)allows ease of access for small bowel visualization and has multiple diagnostic and therapeutic indications.It provides the advantage of performing various therapeutic interve...BACKGROUND Single balloon enteroscopy(SBE)allows ease of access for small bowel visualization and has multiple diagnostic and therapeutic indications.It provides the advantage of performing various therapeutic interventions alongside the diagnostic procedure.SBE has also been considered a relatively safe procedure with no major complications.AIM To investigate the indications,safety,and clinical yield of SBE,and determine its effect on disease outcome.METHODS A retrospective,descriptive study was conducted at a tertiary care hospital in Karachi,Pakistan.Medical records of 56 adult patients(≥18 years)who underwent SBE between July 2013 and December 2021 were reviewed and data were collected using a structured proforma.A descriptive analysis of the variables was performed using Statistical Package of Social Sciences Version 19.Results are reported as the mean±SD for quantitative variables and numbers and percentages for qualitative variables.Missing data are reported as unknown.RESULTS A total of 56 patients who underwent 61 SBE procedures were included.The mean age was 50.93±16.16 years,with 53.6%of them being males.Hypertension(39.3%)and diabetes mellitus(25.0%)were the most common pre-existing comorbidities.Obscure gastrointestinal bleed(39.3%)was the most common indication for enteroscopy,followed by chronic diarrhea(19.7%)and unexplained anemia(16.4%).The majority of procedures were performed in the endoscopy suite(90.2%)under monitored anaesthesia care(93.4%).Most procedures were diagnostic(91.8%)and completed without complications(95.1%).The depth of examination ranged from 95 cm to 500 cm with a mean of 282.05±90.04 cm.The most common findings were inflammation and ulcerations(29.5%),followed by masses(19.7%)and vascular malformations(14.8%).As a result of the findings,a new diagnosis was made in 47.5%of the cases and a previous one was ruled out in 24.6%of them;65.6%of the cases had a change in management.CONCLUSION SBE is a suitable modality for investigating diseases in the small bowel.It is shown to be technically efficient and reasonably safe and is associated with high diagnostic and therapeutic yield.展开更多
基金Supported by Department of Science and Technology of Liaoning Province,No.2024JH2/102600288 and No.2022JH2/101500013。
文摘BACKGROUND Performing endoscopic retrograde cholangiopancreatography(ERCP)in pati-ents with surgically altered gastrointestinal anatomy poses significant challenges.Double-balloon enteroscopy-assisted ERCP(DBE-ERCP)has emerged as a safe and effective approach in this patient population.This study aims to provide an updated systematic review and meta-analysis of the safety and efficacy of DBEERCP in patients with surgically altered anatomy(SAA),building on previously published evidence.AIM To evaluate the safety and efficacy of DBE-ERCP in patients with SAA through an updated systematic review and meta-analysis and to compare outcomes between short-and long-scope double-balloon enteroscopy(DBE).METHODS A comprehensive search of PubMed,EMBASE,and Web of Science was performed for studies published up to March 2025 investigating DBE-ERCP in patients with surgically altered gastrointestinal anatomy.A random-effects model was applied to conduct a meta-analysis of proportions.The risk of bias was evaluated using the Newcastle-Ottawa Scale and the Joanna Briggs Institute Scale.Heterogeneity was evaluated using the inconsistency statistic(I2).Publication bias was examined using funnel plots and Egger’s regression test.RESULTS A total of 40 studies were included,comprising 10 cohort studies and 30 case series,including 2689 patients who underwent 3478 procedures.The surgical procedures were primarily classified into three categories:Roux-en-Y reconstruction(including hepaticojejunostomy,gastric bypass,and choledochojejunostomy,etc.)in 1156 cases;pancreaticoduodenectomy(performed using either the Whipple or Child technique)in 549 cases;and Billroth II anastomosis in 265 cases.The combined success rate for reaching the papilla was 92%(95%CI:89%-95%).The overall enteroscopy success rate was 89%(95%CI:85%-92%).The pooled diagnostic success rate was 90%(95%CI:85%-95%),while the therapeutic success rate reached 92%(95%CI:89%-95%).Adverse events reported in 5.7%of patients(95%CI:4.1%-7.5%).Subgroup analysis comparing short-scope and long-scope demonstrated that the short DBE was superior in terms of papilla reached rate,enteroscopy success,and procedural success.No significant differences were observed between groups in diagnostic success or adverse events.CONCLUSION DBE-ERCP demonstrates both safety and efficacy in patients with SAA.Compared to long-scope DBE,short-scope DBE shows greater clinical promise;however,further randomized controlled trials are warranted to validate these findings.
文摘BACKGROUND In postsurgical upper gastrointestinal anatomy,motorized spiral enteroscopy(MSE)assisted endoscopic retrograde cholangiopancreaticography(ERCP)was shown feasible and has the advantage that standard ERCP instruments can be used.Therefore,MSE-ERCP appears to be the optimal solution for postsurgical patients,especially with Roux-en-Y anatomy.AIM To show feasibility and safety of MSE-ERCP in patients with Roux-en-Y anatomy.METHODS We retrospectively analyzed all consecutive MSE-ERCP procedures in patients with Roux-en-Y anatomy between September 2021 and May 2023 in an endoscopic tertiary referral center.RESULTS We identified 26 MSE-ERCPs:(1)18 MSE-ERCPs in 13 patients with Roux-en-Y anatomy after liver transplantation(n=11)or gastrectomy(n=2);and(2)Another 8 MSE-ERCP interventions in 5 patients with very long Roux-en-Y situation after gastric bypass.Overall success of reaching the biliary entry was 88%and further interventions were successful in 83%of patients.In very long alimentary limb situations,success of reaching the biliary entry was not-significantly lower compared to“standard”Roux-en-Y(75%vs 94%,P=0.215).ERCP-interventions were not-significantly less successful in patients with native papilla compared to hepaticojejunostomy(63%vs 93%,P=0.103).Mean intervention time was 105 minutes.Intervention times were longer in very long limb situations(133 minutes vs 91 minutes;P=0.032).Overall,we observed three adverse events(n=1 caused by enteroscopy,n=1 caused by the biliary intervention,n=1 unrelated to the procedure).In 15/26 cases(58%)MSE-ERCP was carried out on an outpatient basis.CONCLUSION MSE-ERCP has been a promising technique for patients with Roux-en-Y reconstruction requiring biliary interventions.However,MSE was recently withdrawn from the market due to severe safety concerns,which were not observed in this study.
文摘BACKGROUND Single-balloon enteroscopy(SBE)is an established procedure for evaluating small bowel lesions.While its efficacy is well recognized,the incidence of major complications and their associated risk factors in a large population remain unclear.AIM To investigate the complications and risk factors associated with diagnostic SBE.METHODS This multicenter retrospective study included consecutive patients who underwent diagnostic SBE at three tertiary care hospitals between January 2016 and September 2024.Data on baseline characteristics,procedural parameters,indications,findings,and major complications were collected and analyzed.RESULTS A total of 2865 SBE procedures were performed in 1840 patients.The mean age was 51±18 years,and 64.5%were male.The most common indication was obscure gastrointestinal bleeding(57.1%),followed by abdominal pain(30.5%).The major complication rate was 0.4%(7/1840),all of which involved acute intestinal perforation identified during the procedure.Among the perforation cases,6 occurred in patients undergoing SBE for abdominal pain and 1 for obscure gastrointestinal bleeding.The perforation sites included the ileum(6/7)and duodenum(1/7).All cases were successfully managed surgically.Previous abdominal surgery and the use of abdominal compression were significantly associated with an increased risk of perforation(P value<0.001 for both).In subgroup analysis,perforation rates were 2.1%(6/288)in patients with prior abdominal surgery and 1.6%(7/428)with abdominal compression.CONCLUSION Acute intestinal perforation is a rare but serious complication.Prior abdominal surgery and abdominal compression are important risk factors,and careful patient selection is recommended to minimize complications.
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.
文摘Performing endoscopic retrograde cholangiopancreatography (ERCP) in patientswith Roux-en-Y-anatomy is technically challenging and additional techniquesincluding balloon-assisted enteroscopy, endoscopic ultrasound (EUS) guided, andpercutaneous approaches offers only modest success rates. Motorized spiralenteroscopy (MSE)-assisted ERCP (MSE-ERCP) has emerged as a potentialalternative. In a retrospective study by Nennstiel et al, MSE-ERCP achieved highsuccess rates for biliary entry (88%) and therapeutic intervention (83%). However,outcomes varied significantly between bilioenteric anastomosis (93%) and nativepapilla (63%), underscoring the importance of anatomy-driven proceduralselection. Despite encouraging efficacy, the global withdrawal of the MSE platformdue to serious device-related complications highlights the ongoing balancebetween feasibility and safety. Future directions should prioritize refinements indevice engineering, multicenter prospective trials comparing MSE with balloonassistedand EUS-guided techniques, and systematic outcome stratification byanatomical subgroup. Such efforts will be critical to defining the role of MSEwithin the therapeutic algorithm for surgically altered anatomy.
文摘BACKGROUND Small-bowel disorders,including obscure gastrointestinal bleeding(OGIB),Crohn's disease,and tumors,require accurate diagnostic approaches for effective treatment.Video capsule endoscopy(VCE)and simple balloon enteroscopy(SBE)are widely used;however,each modality has limitations,particularly regarding therapeutic intervention and diagnostic yield.AIM To evaluate diagnostic yields of various modalities for small bowel bleeding,analyze factors affecting heterogeneity,and improve understanding of clinical outcomes associated with different diagnostic approaches.METHODS A comprehensive search of four databases(PubMed,Embase,Cochrane Library,and Scopus)revealed over 600 citations related to the use of capsule endoscopy and balloon enteroscopy for diagnosing small intestine disorders with wall thickening.Based on predetermined eligibility criteria,seven moderateto-high-quality retrospective studies were analyzed to evaluate the diagnostic performance of VCE and SBE in patients with small bowel disorders.Quality Assessment of Diagnostic Accuracy Studies was applied to evaluate the risk of bias and overall methodological quality.RESULTS Analysis of seven moderate-to-high-quality retrospective studies revealed comparable overall detection rates for small bowel lesions between VCE and SBE.VCE demonstrated superior performance in detecting vascular lesions.Conversely,SBE exhibited a higher efficacy in detecting ulcerative lesions.The overall diagnostic yield varied across studies,with VCE showing a range of 32%–83%for small bowel bleeding,whereas SBE demonstrated a higher overall detection rate of 69.7%compared to 57.6%for VCE(P<0.05).Notably,SBE showed superior performance in diagnosing Crohn's disease,with a detection rate of 35%,compared to 11.3%for VCE(P<0.001).The diagnostic concordance between VCE and SBE was influenced by the lesion type.Strong agreement was observed for inflammatory lesions(κ=0.82,95%CI:0.75-0.89),whereas moderate agreement was noted for tumors(κ=0.61,95%CI:0.52-0.70)and angiectasias(κ=0.58,95%CI:0.49-0.67).SBE demonstrated significant advantages in therapeutic interventions,particularly in overt bleeding.Patient tolerability was generally higher for VCE,with a completion rate of 95%(95%CI:92%-98%),compared to 85%for SBE(95%CI:80%-90%).However,the capsule retention rate for VCE was 1.4%(95%CI:0.8%-2.0%),necessitating subsequent intervention.CONCLUSION VCE and SBE are complementary techniques for evaluating small intestinal disorders.Although VCE remains the initial test of choice for patients with stable OGIB,SBE should be considered in patients requiring therapeutic intervention.Thus,combining both modalities enhances diagnostic accuracy and patient management.
文摘With the continuous advancement in medical technology,endoscopy has gained significant attention as a crucial diagnostic tool.The introduction of motorized spiral enteroscopy(MSE)represents a significant advancement in the diagnosis and treatment of small bowel diseases.While there are safety concerns and a high reliance on the operator’s skills,MSE should not be disregarded entirely.Instead,it should be considered as a supplementary endoscopic technique,particularly in situations where conventional endoscopy proves ineffective.Through continuous research and technical optimization,MSE has the potential to become an im-portant addition to the endoscopy toolbox in the future.We call on colleagues in the industry to work together to promote the improvement of MSE technology through continuous research and practice,with the aim to bring out its unique value in endoscopy while ensuring patient safety.
文摘Motorized spiral enteroscopy(MSE)is the latest advance in device-assisted enteroscopy.Adverse events related to MSE were discussed in a recent large systematic review and meta-analysis and were directly compared with those of balloon enteroscopy in a case-matched study and a randomized controlled trial.Following the real-life application of MSE,an unexpected safety issue emerged regarding esophageal injury and the technique has been withdrawn from the global market,despite encouraging results in terms of diagnostic and therapeutic yield.We conducted an Italian multicenter real-life prospective study,which was prematurely terminated after the withdrawal of MSE from the market.The primary goals were the evaluation of MSE performance(both diagnostic and therapeutic)and its safety in routine endoscopic practice,particularly in the early phase of introduction in the endoscopic unit.A subanalysis,which involved patients who underwent MSE after unsuccessful balloon enteroscopy,demonstrated,for the first time,the promising performance of MSE as a rescue procedure.Given its remarkable performance in clinical practice and its potential role as a backup technique following a previously failed enteroscopy,it may be more appropriate to refine and enhance MSE in the future rather than completely abandoning it.
文摘Background: Endoscopic treatment of biliopancreatic pathology is challenging due to surgically altered anatomy after Whipple's pancreaticoduodenectomy. This study aimed to evaluate the feasibility and safety of single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography(SBE-ERCP) to treat biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants. Methods: We retrospectively analyzed 106 SBE-ERCP procedures in 46 patients with Whipple's variants. Technical and clinical success rates and adverse events were evaluated. Results: Biliary SBE-ERCP was performed in 34 patients and pancreatic SBE-ERCP in 17, including 5 with both indications. From a total of 106 SBE-ERCP procedures, 76 were biliary indication with technical success rate of 68/76(90%) procedures and clinical success rate of 30/34(88%) patients. Mild adverse event rate was 8/76(11%), without serious adverse events. From a total of 106 SBE-ERCP procedures, 30 were pancreatic indication with technical success rate of 24/30(80%) procedures( P = 0.194 vs. biliary SBEERCP) and clinical success rate of 11/17(65%) patients( P = 0.016 vs. biliary SBE-ERCP). Mild adverse event rate was 6/30(20%)( P = 0.194 vs. biliary SBE-ERCP), without serious adverse events. After SBE-ERCP failure, endoscopic ultrasound-guided drainage, percutaneous drainage and redo surgery were alternative therapeutic options. Conclusions: Biliopancreatic pathology after Whipple's pancreaticoduodenectomy variants can be treated using SBE-ERCP without serious adverse events. Technical and clinical success rates are high for biliary indications, whereas clinical success rate of pancreatic indications is significantly lower. SBE-ERCP can be considered as first-line treatment option in this patient group with surgically altered anatomy.
文摘The diagnosis and opportunity for endoscopic therapy of gastric or duodenal lesions may be missed at esophagogastroduodenoscopy(EGD) because of technical difficulty in intubating at EGD the postoperatively excluded stomach and proximal duodenum in patients status post Roux-en-Y gastric bypass(RYGB). Two cases are reported of acute upper gastrointestinal bleeding 10 or 11 years status postRYGB, performed for morbid obesity, in which the EGD was non-diagnostic due to failure to intubate the excluded stomach and proximal duodenum, whereas subsequent push enteroscopy or single balloon enteroscopy were diagnostic and revealed 4-cm-wide or 5-mm-wide bulbar ulcers and even permitted application of endoscopic therapy. These case reports suggest consideration of push enteroscopy, or single balloon enteroscopy, where available, in the endoscopic evaluation of acute UGI bleeding in patients status post RYGB surgery when the EGD was non-diagnostic because of failure to intubate these excluded segments.
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.
文摘Celiac disease （CD） is an autoimmune inflammatory disease of the small intestine as a result of reaction to wheat protein, gluten. Exclusion of dietary gluten is the mainstay of the treatment that necessitates a precise diagnosis of the disease. Serological screen ing may aid in identifying patients with suspected CD, which should be confirmed by intestinal biopsy. It has been shown that duodenal biopsies are good for de- tection of the disease in most patients. However, there is a group of patients with positive serology and incon- clusive pathology. As a result of the widespread use of serology, many patients with equivocal findings grow quickly. Unfortunately current endoscopic methods can only diagnose villous atrophy, which can be present in the later grades of disease （i.e., Marsh m）. To diag- nose CD correctly, going deeper in the intestine may be necessary. Enteroscopy can reveal changes in CD in the intestinal mucosa in 10%-17% of cases that have negative histology at initial workup. Invasiveness of the method limits its use. Capsule endoscopy may be a good substitute for enteroscopy. However, both tech- niques should be reserved for patients with suspected diagnosis of complications. This paper reviews the cur- rent literature in terms of the value of enteroscopy for diagnosis of CD.
文摘AIM To evaluate the therapeutic role of double-balloon enteroscopy(DBE) in small bowel strictures and to propose a standard approach to small bowel strictures.METHODS Systematic review of studies involving DBE in patients with small bowel strictures. Only studies limited to small bowel strictures were included and those with ileo-colonic strictures were excluded. RESULTS In total 13 studies were included,in which 310 patients were dilated. The average follow-up time was 31.8 mo per patient. The complication rate was 4.8% per patient and 2.6% per dilatation. Surgery was avoided in 80% of patients. After the first dilatation,46% were treated with re-dilatation and only 17% required surgery.CONCLUSION DBE-assisted dilatation avoids surgery in 80% of patients with small bowel strictures and is safe and effective. We propose a standardized approach to small bowel strictures.
文摘Small bowel tumors(SBTs)have been increasingly diagnosed in recent decades.The pathogenesis of this increment is largely unknown,but advances in radiological and endoscopic methods facilitate the improvement of the diagnosis.Capsule endoscopy(CE)and device-assisted enteroscopy(DAE)allow the clinician to assess the entire small bowel in the search for suspicious lesions,or a cause of symptoms.In this review,we discuss the role of enteroscopy,techniques and strategies in the diagnosis and management of SBTs,and a brief description of the most common tumors.
文摘Since its introduction in 2001 capsule endoscopy opened up the small bowel for diagnostic approaches followed by double balloon enteroscopy which enabled the endoscopic community to perform therapeutic interventions in the whole small intestine.In this review the scientific developments related to indications,diagnostic yield and complications of the last years between the competing devices double ballon enteroscopy,single balloon enteroscopy and spiral enteroscopy are illustrated.
文摘Objective:To investigate the feasibility and safety of achieving total enteroscopy by consecutive bidirectional double-balloon enteroscopy(DBE)procedures.Methods:The demographic data,indication,initial insertion route,examination time for each insertion and the entire procedure,total enteroscopy rate,diagnostic yield and adverse events of patients who attempted to achieve total enteroscopy by consecutive bidirectional DBE procedures from January 2014 to December 2019 were retrospectively analyzed.
文摘Inflammatory bowel disease(IBD)includes Crohn’s disease(CD),ulcerative colitis and unclassified entities.CD commonly involves the terminal ileum and colon but at the time of diagnosis it can be confined to the small bowel(SB)in about 30%of the patients,especially in the young ones.Management of isolated SB-CD can be challenging and objective evaluation of the SB mucosa is essential in differentiating CD from other enteropathies to achieve therapeutic decisions and to plan the follow-up.The introduction of cross-sectional imaging techniques and capsule endoscopy(CE)have significantly expanded the ability to diagnose SB diseases providing a non-invasive test for the visualization of the entire SB mucosa.The main CE limitations are the low specificity,the lack of therapeutic capabilities and the impossibility to take biopsies.Device assisted enteroscopy(DAE)enables histological confirmation when traditional endoscopy,capsule endoscopy and cross-sectional imaging are inconclusive and also allows therapeutic interventions such as balloon stricture dilation,intralesional steroid injection,capsule retrieval and more recently stent insertion.In the current review we will discuss technical aspect,indications and safety profile of DAE in children and adults with IBD.
文摘The single-balloon enteroscopy(SBE) system was launched in 2007, proposed as a simpler method than double-balloon enteroscopy(DBE). Controversy surrounds whether the SBE system has the same insertability as DBE. However, many methods have been proposed to improve the depth of insertion with the SBE system, involving several techniques and endoscopic accessories. SBE is used for investigating not only small bowel diseases, but also diseases of the pancreatobiliary and colonic structures. SBE is a necessary advancement for many endoscopic procedures and applications in modern clinical practice. In our review, we summarized the current literature concerning the insertability of SBE and described the technical aspects of improving the rate of deep insertion in SBE procedures. In addition, the recent applications of SBE to diseases besides those of the small bowel are described.
文摘BACKGROUND Obscure gastrointestinal(GI)bleeding is defined as persistent bleeding despite negative evaluation with both esophagogastroduodenoscopy and colonoscopy and can be secondary to small intestinal pathology.Standard endoscopy as well as push endoscopy can be a challenge in those with altered anatomy given inaccessible areas as well as perforation risk.Single and double balloon enteroscopy can be warranted in this patient population in instances of obscure GI bleed.AIM To assess the safety and diagnostic efficacy of balloon enteroscopy for obscure GI bleeding in patients with surgically altered anatomy.METHODS A search was conducted through PubMed,MEDLINE,Google Scholar,Scopus,and Embase with the key words“enteroscopy,”“obscure bleeding,”and“altered anatomy,”to identify relevant articles in English with no restricted time frame.A search within the Reference Citation Analysis database was conducted to ensure inclusion of the latest high impact articles.Study types included in the review were prospective and retrospective reviews,case series,and case reports.The reference lists of these papers were also reviewed to find further papers that were applicable.The authors extracted the data from the studies that fit inclusion criteria.Data of interest included type of study,type of procedure,and type of altered anatomy,as well as the number of patients with any diagnostic or therapeutic intervention.Data was also recorded on procedure tolerance and complications.The data was analyzed with descriptive statistics.RESULTS Our literature search yielded 14 studies that were included.There were 68 procedures performed with 61 unique patients subjected to these procedures.Forty-four(65%)of the procedures were double balloon,21(31%)were single balloon,and 3(4%)were classified as through the scope balloon assisted.The most common altered anatomy types included Gastric Bypass Roux-en-Y,Pylorus Sparing Whipple,Orthotopic Liver Transplantation with Roux-en-Y,and Gastrojejunostomy Roux-en-Y.The procedures were successfully performed in each patient.There were 5(7%)procedures that were complicated by perforation.Amongst the available data,the diagnostic yield was 48/59(81%)and a therapeutic yield of 39/59(66%).One patient was recommended surgical revision of their altered anatomy following enteroscopy.CONCLUSION Balloon enteroscopy is a useful diagnostic modality in investigating obscure GI bleeding within those with surgically altered anatomy;however,precautions must be taken as this population may have increased perforation risk.
文摘BACKGROUND Single balloon enteroscopy(SBE)allows ease of access for small bowel visualization and has multiple diagnostic and therapeutic indications.It provides the advantage of performing various therapeutic interventions alongside the diagnostic procedure.SBE has also been considered a relatively safe procedure with no major complications.AIM To investigate the indications,safety,and clinical yield of SBE,and determine its effect on disease outcome.METHODS A retrospective,descriptive study was conducted at a tertiary care hospital in Karachi,Pakistan.Medical records of 56 adult patients(≥18 years)who underwent SBE between July 2013 and December 2021 were reviewed and data were collected using a structured proforma.A descriptive analysis of the variables was performed using Statistical Package of Social Sciences Version 19.Results are reported as the mean±SD for quantitative variables and numbers and percentages for qualitative variables.Missing data are reported as unknown.RESULTS A total of 56 patients who underwent 61 SBE procedures were included.The mean age was 50.93±16.16 years,with 53.6%of them being males.Hypertension(39.3%)and diabetes mellitus(25.0%)were the most common pre-existing comorbidities.Obscure gastrointestinal bleed(39.3%)was the most common indication for enteroscopy,followed by chronic diarrhea(19.7%)and unexplained anemia(16.4%).The majority of procedures were performed in the endoscopy suite(90.2%)under monitored anaesthesia care(93.4%).Most procedures were diagnostic(91.8%)and completed without complications(95.1%).The depth of examination ranged from 95 cm to 500 cm with a mean of 282.05±90.04 cm.The most common findings were inflammation and ulcerations(29.5%),followed by masses(19.7%)and vascular malformations(14.8%).As a result of the findings,a new diagnosis was made in 47.5%of the cases and a previous one was ruled out in 24.6%of them;65.6%of the cases had a change in management.CONCLUSION SBE is a suitable modality for investigating diseases in the small bowel.It is shown to be technically efficient and reasonably safe and is associated with high diagnostic and therapeutic yield.
