Inspecting the total gastrointestinal tract by consecutive bidirectional double-balloon enteroscopy in patients with suspected small bowel bleeding

Background/Aims: This study aimed to investigate the feasibility, efficiency, and clinical significance of examining the total gastrointesti-nal (GI) tract by consecutive bidirectional double-balloon enteroscopy (DBE) within 1 day in patients with suspected small-bowel bleeding.Materials and Methods: From January 2016 to January 2018, the clinical and endoscopic data of 41 patients with suspected small-bow-el bleeding undergoing DBE aimed at inspecting the total GI tract within 1 day.Results: A success rate of 87.8% (36/41) for examining the total GI tract with no adverse event was achieved by consecutive bidirec-tional DBE performed within 1 day. The total examination time was 140.61±36.41 (range, 82-270) minutes. Positive or negative findings of bleeding were detected in 51.2% (21/41) and 48.8% (20/41) patients, respectively. Single bleeding etiology with non-small-bowel lesions (NSBLs) or small-bowel lesions (SBLs) was detected in 12.2% (5/41) and 26.8% (11/41) of patients, respectively. Dual bleeding etiologies, including NSBLs and SBLs, were detected in 12.2% (5/41) of patients. A re-bleeding rate of positive or negative findings was different (4.8% vs. 40.0%; p


1. Raju GS, Gerson L, Das A, Lewis B; American Gastroenterological Association. American Gastroenterological Association (AGA) Insti-tute technical review on obscure gastrointestinal bleeding. Gastro-enterology 2007; 133: 1694-717. [Crossref]

2. Min YW, Kim JS, Jeon SW, et al. Long-term outcome of capsule en-doscopy in obscure gastrointestinal bleeding: a nationwide analysis. Endoscopy 2014; 46: 59-65. [Crossref]

3. Gerson LB, Fidler JL, Cave DR, Leighton JA. ACG Clinical Guideline: Diagnosis and Management of Small Bowel Bleeding. Am J Gastro-enterol 2015; 110: 1265-87. [Crossref]

4. Pennazio M, Spada C, Eliakim R, et al. Small-bowel capsule en-doscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastro- intestinal Endoscopy Clinical Guideline. Endoscopy 2015; 47: 352-76. [Crossref]

5. Van de Bruaene C, Hindryckx P, Van de Bruaene L, De Looze D. Bleeding Lesion of the Small Bowel: an Extensive Update Leaving No Stone Unturned. Curr Gastroenterol Rep 2018; 20: 5. [Crossref]

6. Xin L, Liao Z, Jiang YP, Li ZS. Indications, detectability, positive findings, total enteroscopy, and complications of diagnostic double- balloon endoscopy: a systematic review of data over the first decade of use. Gastrointest Endosc 2011; 74: 563-70. [Crossref]

7. Marmo R, Rotondano G, Casetti T, et al. Degree of concordance between double-balloon enteroscopy and capsule endoscopy in obscure gastrointestinal bleeding: a multicenter study. Endoscopy 2009; 41: 587-92. [Crossref]

8. Fujita M, Manabe N, Honda K, et al. Long-Term Outcome after Double-balloon Endoscopy in Patients with Obscure Gastrointesti-nal Bleeding. Digestion 2010; 82: 173-8. [Crossref]

9. May A, Färber M, Aschmoneit I, et al. Prospective multicenter tri-al comparing push-and-pull enteroscopy with the single- and dou-ble-balloon techniques in patients with small-bowel disorders. Am J Gastroenterol 2010; 105: 575-81. [Crossref]

10. Takano N, Yamada A, Watabe H, et al. Single-balloon versus dou-ble-balloon endoscopy for achieving total enteroscopy: a random-ized, controlled trial. Gastrointest Endosc 2011; 73: 734-9. [Crossref]

11. Lenz P, Domagk D. Double-vs. single-balloon vs. spiral enteros-copy. Best Pract Res Clin Gastroenterol 2012; 26: 303-13. [Crossref]

12. Tang SJ, Christodoulou D, Zanati S, et al. Wireless capsule endos-copy for obscure gastrointestinal bleeding: a single-center, one-year experience. Can J Gastroenterol 2004; 18: 559-65. [Crossref]

13. van Turenhout ST, Jacobs MA, van Weyenberg SJ, et al. Diagnos-tic yield of capsule endoscopy in a tertiary hospital in patients with obscure gastrointestinal bleeding. J Gastrointestin Liver Dis 2010; 19: 141-5.

14. Tee HP, Kaffes AJ. Non-small-bowel lesions encountered during double-balloon enteroscopy performed for obscure gastrointestinal bleeding. World J Gastroenterol 2010; 16: 1885-9. [Crossref]

15. Fry LC, Bellutti M, Neumann H, Malfertheiner P, Mönkemüller K. Incidence of bleeding lesions within reach of conventional upper and lower endoscopes in patients undergoing double-balloon enteros-copy for obscure gastrointestinal bleeding. Aliment Pharmacol Ther 2010; 29: 342-9. [Crossref]

16. Lorenceau-Savale C, Ben-Soussan E, Ramirez S, Antonietti M, Lerebours E, Ducrotté P. Outcome of patients with obscure gastro-intestinal bleeding after negative capsule endoscopy: results of a one-year follow-up study. Gastroenterol Clin Biol 2010; 34: 606-11. [Crossref]

17. Robinson C A, Jackson C, Condon D, Gerson LB. Impact of inpa-tient status and gender on small-bowel capsule endoscopy findings. Gastrointest Endosc 2011; 74: 1061-6. [Crossref]

18. May A, Nachbar L, Schneider M, Neumann M, Ell C. Push-and-pull enteroscopy using the double-balloon technique: method of assessing depth of insertion and training of the enteroscopy tech-nique using the Erlangen Endo-Trainer. Endoscopy 2005; 37: 66-70. [Crossref]

19. Di Caro S, May A, Heine DG, et al. The European experience with double-balloon enteroscopy: indications, methodology, safety, and clinical impact. Gastrointest Endosc 2006; 62: 545-50. [Crossref]

20. Sun B, Rajan E, Cheng S, et al. Diagnostic yield and therapeutic impact of double-balloon enteroscopy in a large cohort of patients with obscure gastrointestinal bleeding. Am J Gastroenterol 2006; 101: 2011-5. [Crossref]

21. Kushnir, Vladimir M, Tang, et al. Long-Term Outcomes After Sin-gle-Balloon Enteroscopy in Patients with; Obscure Gastrointestinal Bleeding. Dig Dis Sci 2013; 58: 2572-9. [Crossref]

22. Yano T, Yamamoto H, Sunada K, et al. Endoscopic classification of vascular lesions of the small intestine. Gastrointest Endosc 2008; 67: 169-72. [Crossref

]23. Kopacova M, Tacheci I, Rejchrt S, Bartova J, Bures J. Double-bal-loon enteroscopy and acute pancreatitis. World J Gastroenterol 2010; 16: 2331-40. [Crossref]

24. Shishido T, Oka S, Tanaka S, et al. Outcome of patients who have undergone total enteroscopy for obscure gastrointestinal bleeding. World J Gastroenterol 2012; 18: 666-72. [Crossref]

25. Shinozaki S, Yano T, Sakamoto H, et al. Long-Term Outcomes in Patients with Overt Obscure Gastrointestinal Bleeding After Negative Double-balloon Endoscopy. Dig Dis Sci 2015; 60: 3691-6. [Crossref]

26. Tu CH, Kao JY, Tseng PH, et al. Early timing of single balloon en-teroscopy is associated with increased diagnostic yield in patients with overt small bowel bleeding. J Formos Med Assoc 2019; 118: 1644-51. [Crossref],

27. Rondonotti E, Spada C, Adler S, et al. Small-bowel capsule en-doscopy and device-assisted enteroscopy for diagnosis and treat-ment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2018; 50: 423-46. [Crossref]

28. Teshima CW, Aktas H, van Buuren HR, Kuipers EJ, Mensink PB. Retrograde double-balloon enteroscopy: comparing performance of solely retrograde versus combined same-day anterograde and retro-grade procedure. Scand J Gastroenterol 2011; 46: 220-6.

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