Evaluation of small bowel wall thickness with double balloon enteroscopy

Yıl 2023, Cilt: 3 Sayı: 4, 132 - 138, 29.10.2023

Bayram Yeşil , Vedat Kılıç , Mahmut Yüksel , Meral Akdoğan Kayhan

https://doi.org/10.56016/dahudermj.1370943

Öz

Objectives: Double balloon enteroscopy (DBE) is an endoscopic method used for the evaluation of small bowel segments. Its advantage over other small bowel evaluation methods is that it allows treatment in addition to the detection of lesions. In this study, we evaluated the results of patients with small bowel abnormalities, especially wall thickness, on radiologic imaging who underwent double-balloon enteroscopy.
Methods: The data of patients who were found to have wall thickness and stenosis in the small intestine on radiological imaging and who underwent DBE between January 2007 and December 2018 at Ankara City Training and Research Hospital were retrospectively analyzed. Patients with inadequate endoscopic images or medical records were excluded from this study.
Results: The study included 112 patients. Of the patients, 69 (61.6%) were male and 43 (38.4%) were female. The mean age of the population was 45.59 ± 17 years. Abdominal pain was the main presenting symptom. The procedure was performed anterograde (oral) in 79 patients, retrograde (anal) in 25 patients, and both approaches in 8 patients. Various complications developed after 20 procedures, and no mortality was observed. Radiologically, small bowel wall thickness was most commonly detected on computed tomography, and the majority of the lesions detected were in the jejunum (63.9%). In 48 DBE procedures, no lesion was detected in the small intestine. The ulcer was the most common lesion detected during DBE (25.6%), and the majority were detected in the ileum. Crohn's disease was the most common pathology detected in the samples. Malignancy was the second most common pathology, and jejunal lymphoma was the most common malignancy.
Conclusion: DBE should be used more frequently in clinical practice to evaluate radiologically detected small bowel lesions because of the possibility of biopsy and its high diagnostic accuracy.

Anahtar Kelimeler

enteroscopy, double-balloon, small bowel wall thickness

Kaynakça

• Yamamoto H, Sekine Y, Sato Y, et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc. 2001;53(2):216-220. doi:10.1067/mge.2001.112181
• Chen WG, Shan GD, Zhang H, et al. Double-balloon enteroscopy in small bowel diseases: Eight years single-center experience in China. Medicine (Baltimore). 2016;95(42):e5104. doi:10.1097/MD.0000000000005104
• Pata C, Akyüz Ü, Erzın Y, Mercan A. Double-balloon enteroscopy: the diagnosis and management of small bowel diseases. Turk J Gastroenterol. 2010;21(4):353-359. doi:10.4318/tjg.2010.0120
• Sun B, Shen R, Cheng S, Zhang C, Zhong J. The role of double-balloon enteroscopy in diagnosis and management of incomplete small-bowel obstruction. Endoscopy. 2007;39(6):511-515. doi:10.1055/s-2007-966376
• Hu J, Wu J, Zhang P, et al. Evaluation of symptomatic small bowel stricture in Crohn's disease by double-balloon endoscopy. BMC Gastroenterol. 2023;23(1):247. Published 2023 Jul 20. doi:10.1186/s12876-023-02839-8
• Chen WG, Shan GD, Zhang H, et al. Double-balloon enteroscopy in small bowel tumors: a Chinese single-center study. World J Gastroenterol. 2013;19(23):3665-3671. doi:10.3748/wjg.v19.i23.3665.
• Lee DK, Cho KY, Cho HH, Seo JW. Bowel Wall Thickening on Computed Tomography in Children: A Novel Method of Measurement and Its Clinical Significance. Pediatr Gastroenterol Hepatol Nutr. 2021;24(3):279-287. doi:10.5223/pghn.2021.24.3.279
• Macari M, Balthazar EJ. CT of bowel wall thickening: significance and pitfalls of interpretation. AJR Am J Roentgenol. 2001;176(5):1105-1116. doi:10.2214/ajr.176.5.1761105
• Finkelstone L, Wolf EL, Stein MW. Etiology of small bowel thickening on computed tomography. Can J Gastroenterol. 2012;26(12):897-901. doi:10.1155/2012/282603
• ASGE Standards of Practice Committee, Gurudu SR, Bruining DH, et al. The role of endoscopy in the management of suspected small-bowel bleeding. Gastrointest Endosc. 2017;85(1):22-31. doi:10.1016/j.gie.2016.06.013
• Wang P, Wang Y, Dong Y, et al. Outcomes and safety of double-balloon enteroscopy in small bowel diseases: a single-center experience of 1531 procedures. Surg Endosc. 2021;35(2):576-583. doi:10.1007/s00464-020-07418-6
• Lu L, Yang C, He T, et al. Single-centre empirical analysis of double-balloon enteroscopy in the diagnosis and treatment of small bowel diseases: A retrospective study of 466 cases. Surg Endosc. 2022;36(10):7503-7510. doi:10.1007/s00464-022-09179-w.
• Xin L, Liao Z, Jiang YP, Li ZS. Indications, detectability, positive findings, total enteroscopy, and complications of diagnostic double-balloon endoscopy: a systematic review of data over the first decade of use. Gastrointest Endosc. 2011;74(3):563-570. doi:10.1016/j.gie.2011.03.1239
• Tang L, Huang LY, Cui J, Wu CR. Effect of Double-Balloon Enteroscopy on Diagnosis and Treatment of Small-Bowel Diseases. Chin Med J (Engl). 2018;131(11):1321-1326. doi:10.4103/0366-6999.232802
• Abu-Hamda EM, Hattab EM, Lynch PM. Small bowel tumors. Curr Gastroenterol Rep. 2003;5(5):386-393. doi:10.1007/s11894-003-0051-5
• Joensuu H, Hohenberger P, Corless CL. Gastrointestinal stromal tumour. Lancet. 2013;382(9896):973-983. doi:10.1016/S0140-6736(13)60106-3
• Durmush D, Kaffes AJ. Small bowel strictures. Curr Opin Gastroenterol. 2019;35(3):235-242. doi:10.1097/MOG.0000000000000531
• Tapasvi C, Prajapati N, Madhok R, Gupta AK, Taneja V, Aggarwal A. Evaluation of bowel wall thickening by computed tomography to differentiate benign from malignant lesions. J Clin Diagn Res. 2014;8(11):RC09-RC12. doi:10.7860/JCDR/2014/10601.5149
• Catassi C, Verdu EF, Bai JC, Lionetti E. Coeliac disease. Lancet. 2022;399(10344):2413-2426. doi:10.1016/S0140-6736(22)00794-2
• Tomei E, Semelka RC, Braga L, et al. Adult celiac disease: what is the role of MRI?. J Magn Reson Imaging. 2006;24(3):625-629. doi:10.1002/jmri.20664