The Role Of Balloon-Assisted Enteroscopy In The Diagnosis And Treatment Of Incomplete Intestinal Obstruction

Intestinal obstruction refers to the disease which is caused by the delaying of the content getting through the intestine. It is a commonly-seen acute abdomen which is caused by many factors. Small bowel obstruction (SBO) is a common clinical acute abdomen. The proportion of SBO is about60%～80%of the intestinal obstruction. The small intestine is about4-6meters long, and it is separated from the peritoneum and mesenteric bound to the formation of more complex intestinal loop. It is hard to make a definition about the diagnosis and the treatment. There are many factors which may contribute to Bowe focus our attention on the following aspects: small intestinal adhesions, intestinal inflammatory stenos is (the most common such as Cohn’s disease), mall intestine of benign and malignant tumors, diverticulum of small intestine, the small intestine parasites, small intestinal volvulus, small bowel hernia, abdominal tumors to force pressure, and small intestinal paralysis. The diagnosis of SBO mainly rely on previous health, current signs and laboratory examinations. The traditional treatment for small bowel obstruction is mainly divided into three aspects:①Conservative treatment②Surgery③Laparoscopy treatment. According to the degree of obstruction, SBO can be divided into complete and incomplete small bowel obstruction. The complete SBO is always acute, while the incomplete obstruction is chronic. The complete small bowel obstruction is a common acute abdomen, selectlaparotomy or laparoscopy examination and treatment undisputed. The complete small bowel obstruction is a common acute abdomen, there is no doubt to select laparotomy or laparoscopy to treatment. obviously, for a clear diagnosis laparotomy not only to patients with large wounds, and increased risk of postoperative intestinal adhesion. For patients without surgical exploration, also there is the risk of delayed diagnosis and delayed treatment! So clinician faces a dilemma of incomplete small-bowel obstruction in patients. How to improve the Etiology diagnosis rate of incomplete small bowel obstruction is a clinical problem of urgent need to address!The usage of Balloon-assisted enteroscopy ((BAE) Including the double-balloon enteroscopy (DBE) and single-balloon enteroscopy (SBE)) provides new examination and treatment methods for incomplete small bowel obstruction. It improves the diagnosis rate of incomplete obstruction of the small intestine. However, the current reports focus mainly on small sample data, and there are only few reports about endoscopic treatment for benign lesions leading to incomplete obstruction of the small intestine. As a new method for clinical examination and treatment, its clinical utility and security still need to be checked. The aim of this study is to verify the BAE the diagnosis and treatment of incomplete small bowel obstruction.The study compriseds107patients with incomplete intestinal obstruction who underwent a total of139BAE (oral approach87patients, anal approach52patients,32patients underwent both approaches). BAE identified the causes of intestinal obstruction in100patients (93.4%). Small bowel follow-through (SBIF) group of63cases detected lesions in34cases and found no lesions in29cases, the lesion detection rate of54%. Small intestine CT group in46cases of detection of lesions in36cases, the lesion detection rate is78.3%. The detection of BAE group was significantly higher than the traditional inspection groups (P<0.05).62patients (55patients were Peutz-Jeghers syndrome with huge polyps and7patients were benign stricture in small intestine) underwent167BAE endoscopic treatments:polypectomies (N=160) for huge polyps, dilation therapy (N=7) for enterostenosis. After these therapeutic endoscopy, the symptom of intestinal obstruction was disappeared or alleviated in45 patients(72.6%, polypectomy40cases, dilation therapy5cases). Among these167BAE procedures,5serious complications (3%, three small intestine perforations and two bleeding with a fall in Hb) were observed.The above results show that BAE has high diagnostic rate inpatients with incomplete small bowel obstruction, and endoscopic therapy can be used in some patients to avoid unnecessary surgery. It has an important clinical value in the diagnosis and treatment of incomplete SBO.