Endoscopic ultrasonography and small‐bowel endoscopy: Present and future

Over the last decade, impressive technological advances have occurred in ultrasonography and small‐bowel endoscopy. Nowadays, endoscopic ultrasonography is an essential diagnostic tool and a therapeutic weapon for pancreatobiliary disorders. Capsule endoscopy and device‐assisted enteroscopy have quickly become the reference standard for the diagnosis of small‐bowel luminal diseases, thereby leading to radical changes in diagnostic and therapeutic pathways. We herein provide an up‐to‐date overview of the latest advances in endoscopic ultrasonography and small‐bowel endoscopy, focusing on the emerging paradigms and technological innovations that might improve clinical practice in the near future.     

Double-balloon enteroscopy for retrieving retained small-bowel video capsule endoscopes: a systematic review

Abstract

Background and aim: Capsule retention is the most common adverse event associated with video capsule endoscopy. The use of double-balloon enteroscopy-assisted capsule endoscope retrieval has been increasingly reported in recent years. However, evidence is limited regarding its success rate, associated factors, and subsequent clinical outcomes.

Methods: A systematic review of relevant studies published before January 2019 was performed. Successful retrieval rate and associated factors, rate of endoscopic balloon dilation, and outcomes after double-balloon enteroscopy were summarized and pooled.

Results: Within 154 associated original articles, 12 including 150 cases of capsule retrieval by double-balloon enteroscopy were included. The estimated pooled successful retrieval rate was 86.5% (95% confidence interval, 75.6–95.1%). Anterograde approach and capsules retained in the jejunum or trapped by malignant strictures were associated with a higher successful retrieval rate than the retrograde approach (62/83 [74.7%] vs. 10/38 [26.3%], p?<?.001) and capsules retained in the ileum (41/41 [100.0%] vs. 43/58 [74.1%], p?<?.001) or trapped by benign strictures (21/21 [100.0%] vs. 65/83 [78.3%], p?=?.043). Endoscopic balloon dilation was performed in 38.8% (95% confidence interval, 22.3–56.3%) of patients with benign strictures. Two perforations (1.3%) were reported as severe adverse events after double-balloon enteroscopy. A significantly lower surgery rate was found among cases with successful video capsule removal compared with unsuccessful cases (7.2% vs. 38.5%, p?=?.002).

Conclusions: Double-balloon enteroscopy is feasible and safe for removing retained video capsule endoscopes, and its use could decrease the need for surgery in patients with benign strictures and facilitate subsequent surgery in patients with malignant strictures.     

Successful treatment with balloon dilatation using a double‐balloon enteroscope for a stricture in the small bowel of a patient with Crohn's disease

The requirement for endoscopic access to a stricture is a major limitation of the endoscopic dilatation for the treatment of strictures in the gastrointestinal tract. We have developed the double‐balloon enteroscopy method that enables visualization of the entire small bowel. In addition, double‐balloon enteroscopy has a potential for the interventional therapy including dilatation of strictures. We present here a case of jejunal strictures in a 47‐year‐old woman with Crohn's disease successfully treated with a balloon catheter in combination with double‐balloon enteroscopy. Balloon dilation with double‐balloon enteroscopy is a promising method for the treatment of small bowel strictures in Crohn's disease.     

Use of a double balloon enteroscope facilitates caecal intubation after incomplete colonoscopy with a standard colonoscope

BACKGROUND: Caecal intubation is a necessary step in the complete endoscopic evaluation of the colon. Studies have estimated that experienced colonoscopists may fail to reach the caecum in up to 10% of cases. AIMS: To evaluate the utility of the double balloon enteroscope used for complete examination of the colon in patients with incomplete standard colonoscopy. PATIENTS: Twenty consecutive patients with incomplete colonoscopies within the Veterans Affairs Palo Alto Health Care System. Mean age of 66 years (S.D.+/-12 years, range 46-84), 16 men. METHODS: Prospective single-centre case series on the caecal intubation rate using standard double balloon enteroscope technique in patients with previous incomplete conventional colonoscopy. RESULTS: Use of the standard double balloon enteroscope technique permitted complete colonoscopy to be achieved in 95% of the patients (19/20). Seven patients (35%) had significant pathology beyond the extent of the prior incomplete colonoscopy. We performed endoscopic mucosal resection, polypectomy or biopsy. The mean time to reach the caecum was 28 min (S.D.+/-20 min, range 6-90 min). The sedation was similar to conventional colonoscopy. No complications occurred. CONCLUSIONS: The double balloon enteroscope technology and technique can be used to complete examination of the colon in patients who were referred because of incomplete standard colonoscopy.     

NEW METHOD OF STENTING TREATMENT FOR MALIGNANT DUODENAL STENOSIS: USING DOUBLE‐BALLOON ENTEROSCOPY

Recently, a self‐expandable metallic stent has been recognized for treatment of malignant duodenal stenosis. But the complications by stenting are important problems even now. In the present study, we report our new method of duodenal stenting by using of double‐balloon enteroscopy considered safe and effective.     

Intra-operative Total Enteroscopy for the Management of Peutz-Jegher's Syndrome

We present a case of Peutz-Jegher's syndrome in an 18 year old female who was followed for gastrointestinal polyps for 13 years from the age of 5 years. The patient was treated four times with surgical or endoscopic polypectomy for gastrointestinal polyps. At the age of 14 years, a combined surgical and endoscopic approach for the management of Peutz-Jegher's syndrome was carried out. A large polyp of the ileum required enterotomy for its removal, and another smaller polyp of the upper jejunum was identified and removed by intra-operative total enteroscopy via the anus. Intra-operative enteroscopy allows one to identify polyps that would previously have been missed. A more complete polypectomy can be performed using this technique, allowing the patient with Peutz-Jegher's syndrome a longer interval between laparotomies and a reduction in symptoms attributed to polyps.     

不同浓度地佐辛联合丙泊酚麻醉对无痛肠镜患者的临床研究

目的研究分析不同浓度地佐辛加丙泊酚麻醉对行无痛肠镜治疗患者苏醒质量的影响。方法选择2019年1月—2020年1月于我院行无痛肠镜治疗的80例患者为本次研究对象,将其按照随机分组的方式分为甲组和乙组,各40例,甲组予以0.05 mg/kg地佐辛+丙泊酚麻醉,乙组予以0.1 mg/kg地佐辛+丙泊酚麻醉,观察两组丙泊酚用量、苏醒时间和术中不良反应发生情况,并对数据进行分析统计。结果乙组丙泊酚用量低于甲组,且乙组苏醒时间短于甲组,差异具有统计学意义(P<0.05),乙组术中不良反应发生率为7.50%低于甲组25.00%,差异具有统计学意义(P<0.05)。结论地佐辛联合丙泊酚在无痛肠镜治疗患者的麻醉中效果显著,但0.1 mg/kg地佐辛+丙泊酚安全性更高,可有效降低丙泊酚用量,缩短苏醒时间,并降低不良反应发生率,可满足临床麻醉需求,有较高的临床应用价值。     

双腔气囊小肠镜对小肠炎症性疾病相关狭窄的治疗

目的：探讨双腔气囊小肠镜的内镜下球囊扩张(endoscopic balloon dilation,EBD)和狭窄切开(endoscopic stricturotomy with needle knife,NKSt)对于小肠炎症性疾病相关狭窄治疗的安全性及有效性。方法：收集2015年7月至 2018年9月在中南大学湘雅三医院行双腔气囊小肠镜狭窄治疗的患者14例,病变部位16处,内镜下干预16次(EBD 11次 和NKSt 5次)。术后定期随访,观察患者的临床症状缓解和复发情况,以及是否能替代外科手术。结果：14例患者均 成功行内镜治疗,操作成功率100%,未发生穿孔、大出血等严重并发症。EBD和NKSt患者分别在随访5.9~35.3(中位 数26.1)个月及1.6~17.8(中位数8.3)个月内梗阻症状得到有效缓解,其中2例患者随访期间出现再次梗阻,予以保守对 症处理后缓解,未行外科手术干预。结论：小肠镜下治疗(EBD和NKSt)对小肠炎症性疾病狭窄安全有效,可以推迟 外科手术时间。     

自控麻醉在双气囊内镜检查中的应用研究

目的评价自控镇痛(Patient controlled analgesia,PCA)技术在双气囊内镜(double balloon endoscopy,DBE)检查过程中的安全性和可行性。方法共对120例疑有小肠疾病的患者采用未行麻醉处理(A组)、TCI静脉泵输注丙泊酚(B组)、PCA泵静脉输注瑞芬太尼(C组)的3种检查方法,记录患者的血压、心率、血氧饱和度等生命体征,操作成功率、耐受性评分、离院时间、内镜到达肠段深度及病变检出率,对3种方法在双气囊内镜检查中的可行性和安全性进行评价。结果 A组患者耐受性差,检查成功率只达80%,3组操作时间无显著性差异,但到达肠段深度有显著性差异,B组、C组病变检出率高,但B组患者操作中血氧饱和度较操作前下降,使麻醉风险增加。C组患者操作中生命体征与操作前无明显变化,结束及离院时血压、血氧饱和度稳定,降低了麻醉风险。结论本研究认为PCA技术在双气囊内镜检查中的应用,可满足患者在不同时刻的个体化镇痛需要,提高患者对检查的耐受性及依从性,能与操作者进行交流及配合变换体位,可降低操作风险,提高双气囊内镜的操作成功率,具有良好的安全性和优越性。