This new
technique showed promise in two studies.
Because
radiographic studies have poor sensitivity for detecting small-bowel
sources of gastrointestinal bleeding, new techniques have been
developed. Video capsule endoscopy is a major advance, but it doesn't
allow for biopsies or therapeutic interventions. A new approach is
double-balloon enteroscopy (also called "push-and-pull enteroscopy").
Balloons are attached to the distal ends of both an enteroscope and a
transparent tube that slides over it. The balloons can be inflated to
"grip" the small intestine and pull it over the instrument,
allowing visualization of long portions of small bowel. The device
can be inserted orally or anally to visualize proximal or distal
small bowel, respectively.
Two studies
demonstrate the yield of this technique in patients for whom upper
endoscopy and colonoscopy failed to reveal a source of GI bleeding.
In a study from China, double-balloon enteroscopy revealed a
potential bleeding source in 76% of 152 patients, most commonly
angiodysplasia and small-bowel tumors. In a study from Germany, the
diagnostic yield among 52 patients was 73% (vs. a 44% diagnostic
yield with a conventional push enteroscope); mean insertion depth was
230 cm via the oral route. In both studies, argon plasma coagulation
was used to treat sources of bleeding. No serious complications were
reported in either study.
Comment:
Double-balloon enteroscopy is a promising new approach to the
diagnosis and treatment of small-bowel sources of bleeding. The
procedure is currently available only at a handful of U.S. centers,
but that is likely to change. A short
video depicting use of the double-balloon enteroscope can be
viewed online free of charge.
— Allan S.
Brett, MD
Published in
Journal Watch October 24, 2006
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