| Objective At present,double balloon enteroscopy(DBE)has become the main method of clinical diagnosis and treatment of small bowel diseases.The purpose of this study was to evaluate the application value of DBE in the diagnosis and treatment of small bowel diseases according to the age and indications of patients.MethodsThe data of patients who underwent DBE at the Department of Gastroenterology of the General Hospital of Northern Theater Command between April 2012 and August2022 were retrospectively reviewed.Clinical,endoscopic and pathological data of patients were collected,including age,gender,indications,endoscopic results,interventions,complications and so on.According to the age of patients,the included patients were divided into the young group(< 45 years)and the older group(≥45 years);according to the two most common indications of patients,the included patients were divided into obscure gastrointestinal bleeding(OGIB)group and abdominal pain group.Baseline characteristics,endoscopic findings,interventions,and complication rates were compared between the two groups,respectively.ResultsA total of 614 patients who underwent 692 DBE procedures(632 diagnostic and 60therapeutic)were included.Among them,536 patients underwent one examination(228 oral and 308 anal)and 78 patients underwent two-way examinations(oral and transanal approaches).The most common indications were OGIB(43.65%)and abdominal pain(37.95%).The overall detection rate of OGIB patients(70.90%)was higher than that of abdominal pain patients(60.09%),the difference was statistically significant(P=0.011).In patients with OGIB,the most common intestinal lesions of OGIB were erosion/ulcer,followed by space occupation/tumor and mucosal inflammatory changes.In patients with abdominal pain,the most common intestinal lesions were mucosal inflammatory changes,followed by erosion/ulcer and inflammatory bowel disease.The positive diagnosis rates in the young group and the older group were 69.62% and 63.84%,respectively.In the young group,the most common small intestinal lesions were mucosal inflammatory changes.In the older group,the most common lesions were space occupation/tumor and erosion/ulcer lesions.A total of 407 abnormal cases were detected with DBE,the detection rate was66.29%(407/614).The most common positive findings were erosion/ulcer and mucosal inflammatory changes,91 cases each,accounting for 14.82%(91/614).Small bowel Crohn’s disease,mostly in the ileum,accounted for 84.21%(16/19)(P<0.001).Erosion/ulcer(n=72,79.12%,P <0.001)and mucosal inflammatory changes were also mostly located in the ileum(n=70,75.27%,P <0.001).Tumor(n=36,80%,P< 0.001),stromal tumor(n=21,91.30%,P<0.001),and adenocarcinoma(n=9,90%,P<0.001)were mostly located in the proximal small bowel.Vascular lesions(n=12,70.59%,P=0.016)were also mostly located in the proximal small bowel.The most common endoscopic interventions were polypectomy and hemostatic clip marking,followed by hemostatic and preventive hemostatic treatments including hemostatic clip splints,argon plasma coagulation(APC),and hemostatic water spraying,as well as foreign body removal.DBE-associated complications were reported for 5 procedures(0.7%),including 4 diagnostic procedures(0.6%)and 1 therapeutic procedure(1.7%).The patients improved after treatment,and no death occurred in hospital.ConclusionsDBE has a high diagnostic rate for small bowel diseases,especially for small bowel Crohn’s disease and small bowel tumors.The spectrum of disease varies slightly in patients with different age groups and indications.DBE is also a safe and effective method for the treatment of small bowel diseases,including polypectomy,marking and positioning,endoscopic hemostasis,foreign body removal and other treatment methods,which provides a new choice for the treatment of small bowel diseases,and can replace some surgical operations.DBE is a very safe technique with few complications.In general,DBE has important value in the diagnosis and treatment of small bowel diseases. |
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