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Balloon-Assisted Enteroscopy: Techniques, Diagnostic and Therapeutic Yield and Application in Small Bowel Crohn’s Disease

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Abstract

Access to the small bowel has traditionally been limited to the proximal jejunum and terminal ileum. Several techniques including balloon-assisted enteroscopy and spiral enteroscopy now allow for deep enteroscopy and the potential for total enteroscopy in some patients. The balloon-assisted techniques result in a pleating of the intestine over the scope and overtube using a push-pull technique with the balloon(s) providing an anchoring mechanism. These techniques have a potential diagnostic and therapeutic role in the evaluation and management of patients with known or suspected Crohn’s disease of the small intestine, especially where standard endoscopic and imaging techniques are not conclusive or cannot reach the diseased segment.

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References

  1. Yamamoto H, Sekine Y, Sato Y, Higashizawa T, Miyata T, Iino S, et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc. 2001;53(2):216–20.

    Article  CAS  PubMed  Google Scholar 

  2. Tsujikawa T, Saitoh Y, Andoh A, Imaeda H, Hata K, Minematsu H, et al. Novel single-balloon enteroscopy for diagnosis and treatment of the small intestine: Preliminary experiences. Endoscopy. 2008;40(1):11–5.

    Article  CAS  PubMed  Google Scholar 

  3. 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):563–70.

    Article  PubMed  Google Scholar 

  4. Messer I, May A, Manner H, Ell C. Prospective, randomized, single-center trial comparing double-balloon enteroscopy and spiral enteroscopy in patients with suspected small-bowel disorders. Gastrointest Endosc. 2013;77(2):241–9.

    Article  PubMed  Google Scholar 

  5. Arakawa D, Ohmiya N, Nakamura M, Honda W, Shirai O, Itoh A, et al. Outcome after enteroscopy for patients with obscure GI bleeding: Diagnostic comparison between double-balloon endoscopy and videocapsule endoscopy. Gastrointest Endosc. 2009;69(4):866–74.

    Article  PubMed  Google Scholar 

  6. May A, Färber M, Aschmoneit I, Pohl J, Manner H, Lotterer E, et al. Prospective multicenter trial comparing push-and-pull enteroscopy with the single- and double-balloon techniques in patients with small-bowel disorders. Am J Gastroenterol. 2010;105(3):575–81.

    Article  PubMed  Google Scholar 

  7. Domagk D, Mensink P, Aktas H, Lenz P, Meister T, Luegering A, et al. Single- vs double-balloon enteroscopy in small-bowel diagnostics: A randomized multicenter trial. Endoscopy. 2011;43(6):472–6.

    Article  CAS  PubMed  Google Scholar 

  8. Murphy SJ, Kornbluth A. Double balloon enteroscopy in crohn’s disease: Where are we now and where should we go? Inflamm Bowel Dis. 2011;17(1):485–90.

    Article  PubMed  Google Scholar 

  9. Teshima CW, Aktas H, van Buuren HR, Kuipers EJ, Mensink PB. Retrograde double balloon enteroscopy: Comparing performance of solely retrograde versus combined same-day anterograde and retrograde procedure. Scand J Gastroenterol. 2011;46(2):220–6.

    Article  PubMed  Google Scholar 

  10. Triester SL, Leighton JA, Leontiadis GI, Gurudu SR, Fleischer DE, Hara AK, et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn's disease. Am J Gastroenterol. 2006;101(5):954–64.

    Article  PubMed  Google Scholar 

  11. Swaminath A, Legnani P, Kornbluth A. Video capsule endoscopy in inflammatory bowel disease: Past, present, and future redux. Inflamm Bowel Dis. 2010;16(7):1254–62.

    Article  PubMed  Google Scholar 

  12. Delvaux M, Gay G. International conference on capsule and double-balloon endoscopy (ICCD). Paris, 27–28 August 2010. Endoscopy. 2011;43(6):533–9.

    Article  CAS  PubMed  Google Scholar 

  13. Wiarda BM, Stolk M, Heine DG, Mensink P, Thieme ME, Kuipers EJ, Stoker J. Patient burden and patient preference: Comparing magnetic resonance enteroclysis, capsule endoscopy and balloon-assisted enteroscopy. J Gastroenterol Hepatol. 2013;28(3):464–71.

    Article  PubMed  Google Scholar 

  14. Van Assche G, Dignass A, Panes J, Beaugerie L, Karagiannis J, Allez M, et al. The second European evidence-based consensus on the diagnosis and management of crohn's disease: Definitions and diagnosis. J Crohns Colitis. 2010;4(1):7–27.

    Article  PubMed  Google Scholar 

  15. Bourreille A, Ignjatovic A, Aabakken L, Loftus EV, Eliakim R, Pennazio M, et al. Role of small-bowel endoscopy in the management of patients with inflammatory bowel disease: An international OMED-ECCO consensus. Endoscopy. 2009;41(7):618–37.

    Article  CAS  PubMed  Google Scholar 

  16. Mensink PB, Aktas H, Zelinkova Z, West RL, Kuipers EJ, van der Woude CJ. Impact of double-balloon enteroscopy findings on the management of crohn's disease. Scand J Gastroenterol. 2010;45(4):483–9.

    Article  PubMed  Google Scholar 

  17. Ochsenkühn T, Herrmann K, Schoenberg SO, Reiser MF, Göke B, Sackmann M. Crohn disease of the small bowel proximal to the terminal ileum: Detection by mr-enteroclysis. Scand J Gastroenterol. 2004;39(10):953–60.

    Article  PubMed  Google Scholar 

  18. Ryan ER, Heaslip IS. Magnetic resonance enteroclysis compared with conventional enteroclysis and computed tomography enteroclysis: A critically appraised topic. Abdom Imaging. 2008;33(1):34–7.

    Article  PubMed  Google Scholar 

  19. Manes G, Imbesi V, Ardizzone S, Cassinotti A, Pallotta S, Porro GB. Use of double-balloon enteroscopy in the management of patients with crohn's disease: Feasibility and diagnostic yield in a high-volume centre for inflammatory bowel disease. Surg Endosc. 2009;23(12):2790–5.

    Article  PubMed  Google Scholar 

  20. Sunada K, Yamamoto H, Yano T, Sugano K. Advances in the diagnosis and treatment of small bowel lesions with crohn's disease using double-balloon endoscopy. Therap Adv Gastroenterol. 2009;2(6):357–66.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Schulz C, Mönkemüller K, Salheiser M, Bellutti M, Schütte K, Malfertheiner P. Double-balloon enteroscopy in the diagnosis of suspected isolated crohn's disease of the small bowel. Dig Endosc. 2014;26(2):236–42.

    Article  PubMed  Google Scholar 

  22. Mensink PB, Groenen MJ, van Buuren HR, Kuipers EJ, van der Woude CJ. Double-balloon enteroscopy in crohn's disease patients suspected of small bowel activity: Findings and clinical impact. J Gastroenterol. 2009;44(4):271–6.

    Article  CAS  PubMed  Google Scholar 

  23. Hassan C, Zullo A, De Francesco V, Ierardi E, Giustini M, Pitidis A, et al. Systematic review: Endoscopic dilatation in crohn's disease. Aliment Pharmacol Ther. 2007;26(11–12):1457–64.

    Article  CAS  PubMed  Google Scholar 

  24. May A, Nachbar L, Pohl J, Ell C. Endoscopic interventions in the small bowel using double balloon enteroscopy: Feasibility and limitations. Am J Gastroenterol. 2007;102(3):527–35.

    Article  PubMed  Google Scholar 

  25. Despott EJ, Gupta A, Burling D, Tripoli E, Konieczko K, Hart A, Fraser C. Effective dilation of small-bowel strictures by double-balloon enteroscopy in patients with symptomatic crohn's disease (with video). Gastrointest Endosc. 2009;70(5):1030–6.

    Article  PubMed  Google Scholar 

  26. Bhalme M, Sarkar S, Lal S, Bodger K, Baker R, Willert RP. Endoscopic balloon dilatation of Crohn's disease strictures: results from a large United Kingdom series. Inflamm Bowel Dis. 2014;20(2):265–70.

    Article  PubMed  Google Scholar 

  27. Samaha E, Rahmi G, Landi B, Lorenceau-Savale C, Malamut G, Canard JM, et al. Long-term outcome of patients treated with double balloon enteroscopy for small bowel vascular lesions. Am J Gastroenterol. 2012;107(2):240–6.

    Article  CAS  PubMed  Google Scholar 

  28. Van Weyenberg SJ, Van Turenhout ST, Bouma G, Van Waesberghe JH, Van der Peet DL, Mulder CJ, Jacobs MA. Double-balloon endoscopy as the primary method for small-bowel video capsule endoscope retrieval. Gastrointest Endosc. 2010;71(3):535–41.

    Article  PubMed  Google Scholar 

  29. Mensink PB, Haringsma J, Kucharzik T, Cellier C, Pérez-Cuadrado E, Mönkemüller K, et al. Complications of double balloon enteroscopy: A multicenter survey. Endoscopy. 2007;39(7):613–5.

    Article  CAS  PubMed  Google Scholar 

  30. Gerson LB, Tokar J, Chiorean M, Lo S, Decker GA, Cave D, et al. Complications associated with double balloon enteroscopy at nine US centers. Clin Gastroenterol Hepatol. 2009;7(11):1177–82. e1–3.

    Article  PubMed  Google Scholar 

  31. Aktas H, de Ridder L, Haringsma J, Kuipers EJ, Mensink PB. Complications of single-balloon enteroscopy: A prospective evaluation of 166 procedures. Endoscopy. 2010;42(5):365–8.

    Article  CAS  PubMed  Google Scholar 

  32. Aktas H, Mensink PB, Haringsma J, Kuipers EJ. Low incidence of hyperamylasemia after proximal double-balloon enteroscopy: Has the insertion technique improved? Endoscopy. 2009;41(8):670–3.

    Article  CAS  PubMed  Google Scholar 

  33. May A, Nachbar L, Pohl J, Ell C. Endoscopic interventions in the small bowel using double balloon enteroscopy: Feasibility and limitations. Am J Gastroenterol. 2007;102(3):527–35.

    Article  PubMed  Google Scholar 

  34. Oshitani N, Yukawa T, Yamagami H, Inagawa M, Kamata N, Watanabe K, et al. Evaluation of deep small bowel involvement by double-balloon enteroscopy in crohn's disease. Am J Gastroenterol. 2006;101(7):1484–9.

    Article  PubMed  Google Scholar 

  35. Couckuyt H, Gevers AM, Coremans G, Hiele M, Rutgeerts P. Efficacy and safety of hydrostatic balloon dilatation of ileocolonic crohn's strictures: A prospective longterm analysis. Gut. 1995;36(4):577–80.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. Thomas-Gibson S, Brooker JC, Hayward CM, Shah SG, Williams CB, Saunders BP. Colonoscopic balloon dilation of crohn's strictures: A review of long-term outcomes. Eur J Gastroenterol Hepatol. 2003;15(5):485–8.

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Gastroenterology, University of Toronto, St. Michael’s Hospital, 16-058, 30 Bond St, Toronto, ON, Canada, M5B 1W8

    Gary R. May MD, FRCPC, FASGE

Authors
  1. Gary R. May MD, FRCPC, FASGE
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Correspondence to Gary R. May MD, FRCPC, FASGE .

Editor information

Editors and Affiliations

  1. Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA

    Richard Kozarek

  2. Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, USA

    Michael Chiorean

  3. Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA

    Michael Wallace

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Balloon dilatation of a Crohn’s stricture (MP4 105132 kb)

Treatment of bleeding anastomotic ulcer in a Crohn’s patient (MP4 128406 kb)

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May, G.R. (2015). Balloon-Assisted Enteroscopy: Techniques, Diagnostic and Therapeutic Yield and Application in Small Bowel Crohn’s Disease. In: Kozarek, R., Chiorean, M., Wallace, M. (eds) Endoscopy in Inflammatory Bowel Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-11077-6_8

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  • DOI: https://doi.org/10.1007/978-3-319-11077-6_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-11076-9

  • Online ISBN: 978-3-319-11077-6

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