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。     

口服米索前列醇联合宫腔吸引管在剖宫产术后无痛人流的应用

分析口服米索前列醇联合宫腔吸引管治疗剖宫产术后无痛人流的临床效果及机制。120例患者随机分为对照组(n=60)和观察组(n=60)。对照组患者接受宫腔吸引管处理,观察组患者口服米索前列醇(0.6 mg)后接受宫腔吸引管。结果显示观察组患者的手术时间和苏醒时间明显缩短(P<0.05),术中出血量和异丙酚用量明显减少(P<0.05);观察组患者的宫颈扩张效果总有效率明显升高(P<0.05)而不良反应发生率明显降低(P<0.05);两组患者治疗后血清中白细胞介素1β(IL-1β)和IL-2水平明显升高,且对照组患者的上述白细胞介素水平升高更显著(P<0.05)而雌激素促黄体生成素(Luteotropic hormone,LH)、促卵泡激素(Follicle stimulating horman,FSH)和雌二醇(Estradiol,E2)水平无明显变化(P>0.05)。实验表明口服米索前列醇联合宫腔吸引管治疗剖宫产术后无痛人流临床效果明显,且不引起白细胞介素和雌激素水平的剧烈变化。     

利宁凝胶联合丙泊酚用于无痛流产术效果观察

目的观察利宁凝胶联合丙泊酚用于无痛流产术中的效果。方法将600例早孕妇女随机分为观察组和对照组各300例,观察组采用利宁凝胶宫颈表面麻醉联合丙泊酚静脉麻醉,对照组仅用丙泊酚静脉麻醉。观察两组宫颈松弛度、肢体或身体扭动、呻吟下腹痛、手术时间、麻醉用药量、出血量。结果观察组宫颈松弛度明显好于对照组,疼痛发生率及平均手术时间、平均出血量明显低于对照组,P<0.05或0.01。结论利宁凝胶联合丙泊酚应用于无痛流产麻醉镇痛效果好,且较为安全,值得临床借鉴。