| Objective: The small bowel is the longest part of the gastrointestinal tract withthe length5-7m in adult. It is absolutely difficult to examine the small intestinalbecause of insidious onste, unconspicuous symptom specificity and deep location.DBE is a novel endoscopic technique breakthrough developed to investigate smallbowel disease. There is limited available multicentre and large data on its impact inthe diagnosis of the small intestinal. In terms of current issues, to systematicallyanalyze data on diagnostic rate, disease classification, observation scope, andcomplications via DBE for small-bowel disease, and to further evaluate its clinicalvalue and security.Materials and Methods:Atotal of1036patients(585men,451women)withsuspected or previously known small-bowel disease underwent1202DBEprocedures(oral589, anal613, both approaches184)under anesthesia with propofol atour institution. DBE type is FUJINON EN-450P5/28.All patients finishedpreoperative conversation and signed informed consent. Besides, routine laboratorytests and examinations are no-taboo of endoscope and anesthesia. The wholeprocedure is under the electrocardiograph monitoring supervision. On the basis ofpatient information, we choose the best approach of insertion route. Enteroscopy continued until the target furthermost location was reached. In addition to directobservation, a part of patiences should sample from suspicious tissues.Results:Among all the cases, the success rate of DBE was99.2%(1193/1202)and the positive diagnosis yield of double-balloon endoscope resulted84.5%(875/1036). The main diagnosis were polyps/tumors (391/875;44.7%),erosions/ulcerations (246/875;28.1%), and angiodysplasia (52/875;5.94%). Themean duration of the procedure was78min±43min (30-180min). On average,231cm±74cm of the small bowel was visualized by using the oral route and176cm±69cm was visualized by using the anal route (P＜0.05). Nine cases failed: one oralinsertion case was due to congenital small intestinal development malformation; oneoral insertion case was due to severe adhesion of intestine; one anal insertion case wasdue to narrowed ileocecal junction; six anal insertion cases were due to narrowedterminal ileum. Most common lesions detected of OGIB (obscure gastrointestinalbleeding, OGIB) group were ulcers and erosions (57/218;26.1%), vascular diseases(33/218;15.1%), tumors and polyps (28/218;12.8%). Routine omission diagnose ratewas21.6%(47/218) include gastroscope omission diagnose rate of9.63%andcolonoscope omission diagnose rate of11.9%.Among63small bowel tumor cases,45were malignant (45/63;71.4%) and18were benign (18/63;28.5%). Malignancydominates. Histopathology was consistent with the endoscopic diagnosis in87.5%(63/72)of patients with small bowel tumors. Clinical manifestation wasalimentary tract hemorrhage(30cases)、abdominal pain(17cases)、small bowelobstruction(11cases) and nausea(5cases). The main pathology classification of smallbowel malignant tumor were interstitialoma(25/63;39.7%), adenocarcinoma(10/63;15.9%), and lymphoma(6/63;9.52%). Severe complications were observed in11/1202(0.915%) involved eight oral insertion cases(0.665%;8/1202)which manifestedapparent respiratory depression; one oral insertion case(0.083%;1/1202)which wasdue to secondary aspiration pneumonia; and two anal insertion cases (0.166%;2/1202)owing to intraoperative perforation.Aminority of patients complained of light sorethroat or pain in the pars analis or abdominal distension after the DBE proceed. Therewere no other severe complication such as acute pancreatitis and paralytic ileus. Conclusion: Our retrospective analysis shows that DBE is a safe and effectivemethod to diagnose small bowel disorders by visualization and tissue sampling toassist diagnosis of etiology in histology or molecular biology respect. There are broadprospects for DBE. |
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