Effect Of Double-balloon Enteroscopy On Diagnosis And Treatment Of Small-bowel Diseases

Background: The small bowel is vital for digestion and absorption.Anatomically,it is located between the stomach and the large bowel,which is beyond the reach of ordinary endoscopic examination.Therefore,it is called the “blind area” of the digestive tract,making the diagnosis and treatment of small-bowel diseases clinically difficult.The purpose of this study was to evaluate the diagnostic and therapeutic value of double-balloon enteroscopy in small-bowel diseases.Methods: The history and outcomes of 2806 patients who underwent double-balloon enteroscopy from July 2004 to April 2017 were reviewed,which included 562(20.0%)patients with obscure digestive tract bleeding,457(16.3%)patients with obscure diarrhea,930(33.1%)patients with obscure abdominal pain,795(28.3%)patients with obscure weight loss,and 62(2.2%)patients with obscure intestinal obstruction.Examinations were performed through the mouth and/or anus according to the clinical symptoms and abdominal images.If a lesion was not detected through one direction,examination through the other direction was performed as necessary.Results: A total of 2806 patients underwent double-balloon enteroscopy,and no serious complications occurred.An endoscopic approach through both the mouth and anus was used in 212 patients.Lesions were detected in 1696 patients,with a detection rate of 60.4%;the rates for obscure digestive tract bleeding,diarrhea,abdominal pain,weight loss,and intestinal obstruction were 85.9%(483/562),73.5%(336/457),48.2%(448/930),49.1%(390/795),and 62.9%(39/62),respectively.Among the 483 patients with obscure digestive tract bleeding,the three most common conditions were nonsteroidal anti-inflammatory drug-related ulcer(17.4%),stromal tumor(14.1%),and allergic purpura(9.4%).Almost all patients examined via the anus tolerated the procedure,with no side effects.Some patients who underwent oral examination without anesthesia had nausea and transient abdominal pain,which resolved spontaneously without any specific treatment.There were no complications related to suffocation,bleeding,and perforation.84 patients with small-bowel polyps,26 with intestinal obstruction caused by enterolith,and 18 with bleeding from Dieulafoy's lesions in the small intestine were treated endoscopically.For patients with small-bowel polyps who underwent endoscopic therapy,no complications such as digestive tract bleeding and perforation occurred.Intestinal obstruction with enteroliths was relieved with endoscopic lithotripsy.Among the 18 patients with bleeding from small-bowel Dieulafoy's lesions,14 patients were controlled with endoscopic hemostasis.Conclusion: Double-balloon enteroscopy is safe and effective for diagnosing small-bowel diseases.For some small-bowel polyps,small intestinal obstruction caused by an enterolith,and small intestinal bleeding from Dieulafoy's lesion,endoscopic therapy is a viable alternative to open surgery.Above all,Double-balloon enteroscopy is useful for diagnosing and treating some small-bowel disease.