Efficacy And Safety Of Balloon Assisted Enteroscopy In The Diagnosis And Treatment Of Small Bowel Diseases

Objective:To evaluate the efficacy and safety of balloon assisted enteroscopy(BAE)in the diagnosis and treatment of small bowel diseases.Methods:The clinical data of patients who underwent balloon assisted enteroscopy in the First Affiliated Hospital of Nanchang University from November 2005 to October 2019 were retrospectively analyzed,including clinical,endoscopic and pathological information.The chi-square test or Fisher’s exact test were used to compare the gender and age statistical differences of various small bowel diseases and the statistical differences in the incidence of various small bowel diseases among patients with abdominal pain and obscure gastrointestinal bleeding(OGIB).Results:1792 patients underwent 2159 balloon assisted enteroscopy in total,including 645 cases of transoral operation only,780 cases of transanal operation only,and 367 cases of both transoral and transanal operation.Among them,there were 1488 double-balloon enteroscopy operations and 671 single-balloon enteroscopy operations.The overall lesion detection rate was 52.5%.The most common positive enteroscopic diagnoses were non-specific enteritis(27.4%),Crohn disease(18.8%)and small bowel tumors(16.5%).Some positive enteroscopic diagnoses have distribution differences in gender and age.The overall detection rate of small bowel disease in male patients(56.4%)was higher than that in female patients(45.8%)(P<0.001).The detection rate of non-specific enteritis,Crohn’s disease and Meckel’s diverticulum in male patients was higher than that in female patients(P<0.01),while the detection rate of vascular malformation in female patients was higher than that in male patients(P<0.05).The positive diagnosis rates of enteroscopy in the young group,middle-aged group and elderly group were 52.4%,46.7%and 61.9%,respectively,and there were significant differences in the positive diagnosis rates of enteroscopy among the three groups(P<0.001).The detection rates of Crohn’s disease and Meckel’s diverticulum were higher in young patient(P<0.001),while the detection rates of small bowel tumor,vascular malformation,small bowel diverticulum and parasites were higher in elderly patients(P<0.01).The most common clinical manifestations of patients who underwent BAE were abdominal pain(42.0%)and OGIB(32.9%).The detection rate of small bowel diseases in OGIB patients(67.6%)was significantly higher than that in abdominal pain patients(36.7%)(P<0.001).The most common enteroscopic diagnoses in OGIB patients were non-specific enteritis(15.1%)and small bowel tumor(12.9%),while the common enteroscopic diagnoses for abdominal pain were non-specific enteritis(13.7%)and Crohn’s disease(9.4%).In OGIB patients,the detection rate of small bowel tumor,small bowel diverticulum,vascular malformation,Merkel’s diverticulum,parasite and hemangioma was higher than that of abdominal pain patients(P<0.05).There was no significant difference in the detection rates of nonspecific enteritis,Crohn’s disease,small bowel polyps,intestinal tuberculosis and small bowel foreign bodies between the two clinical manifestations(P>0.05).Among all enteroscopy procedures,there were 42 cases of therapeutic enteroscopy,of which hemostasis(71.4%)was the main treatment modality.Enteroscopy-related complications occurred in only 13 cases(0.6%),which were relieved by endoscopic intervention or conservative treatment.Conclusion:BAE is an effective and safe method for the diagnosis and treatment of small bowel diseases.