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or Chronic Abdominal Pain
*M1735 Benefits and Safety of a Novel Double-Balloon Method Enteroscopy in the Detection of Small Intestinal Abnormalities Keigo Mitsui, Shu Tanaka, Katya Gudis, Tsuguhiko Seo, Masaoki Yonezawa, Kazuhiro Nagata, Yoshiaki Shibata, Isao Shinozawa, Atsushi Tatsuguchi, Shunji Fujimori, Teruyuki Kishida, Choitsu Sakamoto
*M1737 Small-Bowel Tumors Diagnosed and Treated by Double-Balloon Endoscopy: Report of Twelve Cases Michiko Iwamoto, Hironori Yamamoto, Keijiro Sunada, Tomonori Yano, Hiroto Kita, Yutaka Sekine, Yoshikazu Hayashi, Hiroyuki Sato, Tomohiko Miyata, Takaaki Iwaki, Hironari Ajibe, Yoshiyuki Kwamura, Kenichi Ido, Kentarou Sugano
Background: Current endoscopic modalities for detection of lesions in the small intestine present some difficulties with respect to deep insertion and tolerable examination levels for patients. Although the M2A capsule endoscopy hopes to resolve these problems, definitive diagnoses remain elusive due to the difficulties of detailed observation and of obtaining biopsy samples. Aims: To determine whether the novel double balloon method enteroscopy is useful and safe in the detection of lesions in the small intestine, and furthermore to show practical applications of these procedures in a video presentation of several cases. Patients & Methods: 14 cases (15 examinations) were investigated with this method since June 2003 at Nippon Medical School, Tokyo, Japan. A newly developed endoscope, EN-450 P5, with an effective working length reaching 200 cm and an outer diameter of 8.5 mm for double-balloon method (Fujinon Toshiba ES System Corp.) was used. The device also has an overtube, with a full length of 140cm, an outer diameter of 12mm and an inner diameter of 10mm. Both the endoscope and its overtube have one balloon at each tip. Each balloon can be quickly and independently inflated and deflated with a pump for exclusive use. First, the endoscope and its overtube are inserted into the mouth or anus with both balloons deflated. Next, the overtube’s balloon is inflated to secure the tube in the intestine and then the endoscope is inserted further. When the tip of the endoscope is inserted as far as feasible, the balloon on the endoscope tip is inflated, the balloon on the overtube deflated, and the overtube advanced along the endoscope. Each balloon repeats inflation and deflation alternately, until both endoscope and overtube are deeply inserted. Results: Using this method, the endoscope, which makes no redundant loops in the small intestinal tract, can be inserted to sufficient depth. No major complications were seen. In eleven of 14 cases, abnormal findings included: an ulcer in 4 cases, a tumor in 1 case, stenosis in 1 case, and other pathological findings in 2 cases. Conclusions: The novel double-balloon method enteroscopy was successfully performed with both observation and biopsy safely and satisfactorily concluded. This method enabled us, not only to diagnose, but also to explore small intestine pathophysiologies.
BKG: Small-bowel tumors are relatively rare, and early diagnosis is difficult. Our team has developed a new endoscopic method, double-balloon endoscopy that provides improved access to the deep small intestine. Twelve patients with smallbowel tumors were identified from 1999 to 2003 at Jichi Medical School, Tochigi Japan. AIM: To assess the diagnostic and therapeutic impact of double-balloon endoscopy in 12 patients with small-bowel tumors. METHODS: Double-balloon endoscopy (Fujinon EN-450P TYPE20) was used in this study. Diagnostic yields, therapeutic capabilities, tumor location, and complication rate were determined in 12 patients with small-bowel tumors. RESULTS: Eight (67%) males and four (34%) females were examined. Five (41%) patients presented with rectal bleeding, five (41%) patients with anemia, one (10%) patient with diarrhea and one (10%) patient with a palpable abdominal mass. The median age was 64.5 (41-85) years. All of the 12 small-bowel tumors were visualized using double-balloon endoscopy. The pathological diagnoses were made by biopsies and included 4 (33%) adenocarcinomas, 3 (23%) gastrointestinal stromal tumors (GIST), 2 (17%) malignant lymphomas, 2 (17%) large cell carcinomas and 1 (10%) inflammatory myofibroblastic tumor (IMT). One adenocarcinoma was cured by endoscopical mucosal resection (EMR). Two adenocarcinomas, 3 GIST, 2 large cell carcinomas and 1 IMT were resected surgically. The patients with malignant lymphoma received adjuvant therapy. The exact location of the tumors within the small intestine was determined for all patients. This included 3 (23%) tumors in the duodenum, 6 (50%) tumors in the jejunum, 3 (23%) in the ileum. There were no serious complications in this series. CONCLUSIONS: The double-balloon endoscopy was used successfully for the pathological diagnosis and endoscopic treatment of tumors in the small intestine. These results suggest that this new method is useful for diagnosis and treatment of the small-bowel tumors.
*M1736 Intraoperative Enteroscopy for the Diagnosis of Bleeding from Unknown Origin. A Series of 58 Consecutive Patients Ralf Jakobs, Dirk Hartmann, Georg Bolz, Claus Benz, Dieter Schilling, Erhard Siegel, Uwe Weickert, Juergen F. Riemann
*M1738 Double-Balloon Enteroscopy in Patients with Obscure Gastrointestinal Bleeding and/or Chronic Abdominal Pain Andrea D. May, Lars Nachbar, Ahad Wardak, Chriatian Ell
Background/Aims: Despite the use of standard endoscopy techniques a minority of patients with loss of blood from the gastrointestinal tract will not have a definitive diagnosis. Capsule endoscopy might have the potential to close this diagnostic gap. We analysed the results and complications of intraoperative enteroscopy. Patients/Methods: Fifty-eight consecutive patients (mean age: 67 yrs.; 27 male) underwent intraoperative enteroscopy. The indication was bleeding from unknown origin in all patients. All of these patients had abdominal ultrasound and at least one complete endoscopic work-up of the GI-tract including EGD, push- or sonde-type enteroscopy and colonoscopy. Most of them had a barium enema of the small intestine and about 30% of the patients had intraarterial angiography. Intraoperative enteroscopy was performed in general anaesthesia using a standard colonoscope (e.g., Olympus CF-140). Results: The mean minimal hemoglobine level of the 58 pts. was 5.9 g/dl and 37 pts. (63.8%) needed transfusion of packed erythrocytes. A bleeding source was detected in 75.8% of the patients during intraoperative enteroscopy. Thirty-five pts. (60.3%) had angiodysplasias of the small intestine and a tumor was found in nine additional patients (15.5%). Angiodysplasias were treated by argon-plasmacoagulation (n=17 pts.), surgical suture (n=18 pts.) or surgical resection (n=4; patients with multiple angiodysplasias in a well-defined area of the ileum). In the nine patients with a tumor the surgical resection was performed after the intraoperative enteroscopy during the same session. No severe complications were found related to the intraoperative enteroscopy. Conclusion: While overwhelming enthusiasm for capsule endoscopy intraoperative enteroscopy still remains the gold standard for the diagnosis of severe bleeding from unknown origin. The diagnostic efficacy is high when the selection of patient is well-defined and the intraoperative setting provides the opportunity for immediate therapy.
Background: Even in the era of capsule endoscopy, diseases of the small bowel are sometimes difficult to diagnose, and endoscopic treatment is not possible without surgical laparotomy. The new method of carrying out enteroscopy using a doubleballoon technique (DBE) allows not only diagnostic but also therapeutic endoscopic interventions for lesions in the small bowel. Methods: Between the end of March 2003 and the end of November 2003, twenty-three patients (11 men, 12 women; mean age 54 years) with chronic gastrointestinal bleeding and/or abdominal pain underwent 40 enteroscopies using the double-balloon technique. Ten of the 23 patients (43.5%) had prior abdominal surgeries (more than appendecomy). Results: DBE was carried out under sedoanalgesic medication using the oral approach in 21/23 patients and/or the anal approach in 16/23 patients. On an average 260+/ÿ100 cm small bowel could be visualized using the oral route and 140+/ÿ130 cm using the anal route. The total diagnostic yield was 91% (21/23). In 7/23 patients (30%) a new diagnosis was found; in 4/23 patients (17%) a suspected diagnosis could be excluded, in 10/23 patients (48%) the diagnosis found e.g. by means of capsule endoscopy was confirmed or the extent of a known disease was determined and in 2 patients no relevant finding could be diagnosed. In 21/23 (91%) the further treatment was influenced by the results of DBE: argon plasma coagulation of angiodysplasias (6) and Ulcus Dieulafoix (1); beginning or stopping of medical treatment (8); avoiding (3) or leading to (3) a surgical intervention. The enteroscopy system was easy to handle in all cases. No complications occurred. Conclusions: This new enteroscopy system is easy to handle and is safe. Visualization of the whole small bowel is possible using both the oral and anal approaches. Enteroscopy with the double-balloon technique promises to become a standard method for diagnostic and therapeutic endoscopy of the small bowel without surgical laparotomy.
VOLUME 59, NO. 5, 2004
GASTROINTESTINAL ENDOSCOPY
P155
*M1737 Small-Bowel Tumors Diagnosed and Treated by Double-Balloon Endoscopy: Report of Twelve Cases Michiko Iwamoto, Hironori Yamamoto, Keijiro Sunada, Tomonori Yano, Hiroto Kita, Yutaka Sekine, Yoshikazu Hayashi, Hiroyuki Sato, Tomohiko Miyata, Takaaki Iwaki, Hironari Ajibe, Yoshiyuki Kwamura, Kenichi Ido, Kentarou Sugano
Background: Current endoscopic modalities for detection of lesions in the small intestine present some difficulties with respect to deep insertion and tolerable examination levels for patients. Although the M2A capsule endoscopy hopes to resolve these problems, definitive diagnoses remain elusive due to the difficulties of detailed observation and of obtaining biopsy samples. Aims: To determine whether the novel double balloon method enteroscopy is useful and safe in the detection of lesions in the small intestine, and furthermore to show practical applications of these procedures in a video presentation of several cases. Patients & Methods: 14 cases (15 examinations) were investigated with this method since June 2003 at Nippon Medical School, Tokyo, Japan. A newly developed endoscope, EN-450 P5, with an effective working length reaching 200 cm and an outer diameter of 8.5 mm for double-balloon method (Fujinon Toshiba ES System Corp.) was used. The device also has an overtube, with a full length of 140cm, an outer diameter of 12mm and an inner diameter of 10mm. Both the endoscope and its overtube have one balloon at each tip. Each balloon can be quickly and independently inflated and deflated with a pump for exclusive use. First, the endoscope and its overtube are inserted into the mouth or anus with both balloons deflated. Next, the overtube’s balloon is inflated to secure the tube in the intestine and then the endoscope is inserted further. When the tip of the endoscope is inserted as far as feasible, the balloon on the endoscope tip is inflated, the balloon on the overtube deflated, and the overtube advanced along the endoscope. Each balloon repeats inflation and deflation alternately, until both endoscope and overtube are deeply inserted. Results: Using this method, the endoscope, which makes no redundant loops in the small intestinal tract, can be inserted to sufficient depth. No major complications were seen. In eleven of 14 cases, abnormal findings included: an ulcer in 4 cases, a tumor in 1 case, stenosis in 1 case, and other pathological findings in 2 cases. Conclusions: The novel double-balloon method enteroscopy was successfully performed with both observation and biopsy safely and satisfactorily concluded. This method enabled us, not only to diagnose, but also to explore small intestine pathophysiologies.
BKG: Small-bowel tumors are relatively rare, and early diagnosis is difficult. Our team has developed a new endoscopic method, double-balloon endoscopy that provides improved access to the deep small intestine. Twelve patients with smallbowel tumors were identified from 1999 to 2003 at Jichi Medical School, Tochigi Japan. AIM: To assess the diagnostic and therapeutic impact of double-balloon endoscopy in 12 patients with small-bowel tumors. METHODS: Double-balloon endoscopy (Fujinon EN-450P TYPE20) was used in this study. Diagnostic yields, therapeutic capabilities, tumor location, and complication rate were determined in 12 patients with small-bowel tumors. RESULTS: Eight (67%) males and four (34%) females were examined. Five (41%) patients presented with rectal bleeding, five (41%) patients with anemia, one (10%) patient with diarrhea and one (10%) patient with a palpable abdominal mass. The median age was 64.5 (41-85) years. All of the 12 small-bowel tumors were visualized using double-balloon endoscopy. The pathological diagnoses were made by biopsies and included 4 (33%) adenocarcinomas, 3 (23%) gastrointestinal stromal tumors (GIST), 2 (17%) malignant lymphomas, 2 (17%) large cell carcinomas and 1 (10%) inflammatory myofibroblastic tumor (IMT). One adenocarcinoma was cured by endoscopical mucosal resection (EMR). Two adenocarcinomas, 3 GIST, 2 large cell carcinomas and 1 IMT were resected surgically. The patients with malignant lymphoma received adjuvant therapy. The exact location of the tumors within the small intestine was determined for all patients. This included 3 (23%) tumors in the duodenum, 6 (50%) tumors in the jejunum, 3 (23%) in the ileum. There were no serious complications in this series. CONCLUSIONS: The double-balloon endoscopy was used successfully for the pathological diagnosis and endoscopic treatment of tumors in the small intestine. These results suggest that this new method is useful for diagnosis and treatment of the small-bowel tumors.
*M1736 Intraoperative Enteroscopy for the Diagnosis of Bleeding from Unknown Origin. A Series of 58 Consecutive Patients Ralf Jakobs, Dirk Hartmann, Georg Bolz, Claus Benz, Dieter Schilling, Erhard Siegel, Uwe Weickert, Juergen F. Riemann
*M1738 Double-Balloon Enteroscopy in Patients with Obscure Gastrointestinal Bleeding and/or Chronic Abdominal Pain Andrea D. May, Lars Nachbar, Ahad Wardak, Chriatian Ell
Background/Aims: Despite the use of standard endoscopy techniques a minority of patients with loss of blood from the gastrointestinal tract will not have a definitive diagnosis. Capsule endoscopy might have the potential to close this diagnostic gap. We analysed the results and complications of intraoperative enteroscopy. Patients/Methods: Fifty-eight consecutive patients (mean age: 67 yrs.; 27 male) underwent intraoperative enteroscopy. The indication was bleeding from unknown origin in all patients. All of these patients had abdominal ultrasound and at least one complete endoscopic work-up of the GI-tract including EGD, push- or sonde-type enteroscopy and colonoscopy. Most of them had a barium enema of the small intestine and about 30% of the patients had intraarterial angiography. Intraoperative enteroscopy was performed in general anaesthesia using a standard colonoscope (e.g., Olympus CF-140). Results: The mean minimal hemoglobine level of the 58 pts. was 5.9 g/dl and 37 pts. (63.8%) needed transfusion of packed erythrocytes. A bleeding source was detected in 75.8% of the patients during intraoperative enteroscopy. Thirty-five pts. (60.3%) had angiodysplasias of the small intestine and a tumor was found in nine additional patients (15.5%). Angiodysplasias were treated by argon-plasmacoagulation (n=17 pts.), surgical suture (n=18 pts.) or surgical resection (n=4; patients with multiple angiodysplasias in a well-defined area of the ileum). In the nine patients with a tumor the surgical resection was performed after the intraoperative enteroscopy during the same session. No severe complications were found related to the intraoperative enteroscopy. Conclusion: While overwhelming enthusiasm for capsule endoscopy intraoperative enteroscopy still remains the gold standard for the diagnosis of severe bleeding from unknown origin. The diagnostic efficacy is high when the selection of patient is well-defined and the intraoperative setting provides the opportunity for immediate therapy.
Background: Even in the era of capsule endoscopy, diseases of the small bowel are sometimes difficult to diagnose, and endoscopic treatment is not possible without surgical laparotomy. The new method of carrying out enteroscopy using a doubleballoon technique (DBE) allows not only diagnostic but also therapeutic endoscopic interventions for lesions in the small bowel. Methods: Between the end of March 2003 and the end of November 2003, twenty-three patients (11 men, 12 women; mean age 54 years) with chronic gastrointestinal bleeding and/or abdominal pain underwent 40 enteroscopies using the double-balloon technique. Ten of the 23 patients (43.5%) had prior abdominal surgeries (more than appendecomy). Results: DBE was carried out under sedoanalgesic medication using the oral approach in 21/23 patients and/or the anal approach in 16/23 patients. On an average 260+/ÿ100 cm small bowel could be visualized using the oral route and 140+/ÿ130 cm using the anal route. The total diagnostic yield was 91% (21/23). In 7/23 patients (30%) a new diagnosis was found; in 4/23 patients (17%) a suspected diagnosis could be excluded, in 10/23 patients (48%) the diagnosis found e.g. by means of capsule endoscopy was confirmed or the extent of a known disease was determined and in 2 patients no relevant finding could be diagnosed. In 21/23 (91%) the further treatment was influenced by the results of DBE: argon plasma coagulation of angiodysplasias (6) and Ulcus Dieulafoix (1); beginning or stopping of medical treatment (8); avoiding (3) or leading to (3) a surgical intervention. The enteroscopy system was easy to handle in all cases. No complications occurred. Conclusions: This new enteroscopy system is easy to handle and is safe. Visualization of the whole small bowel is possible using both the oral and anal approaches. Enteroscopy with the double-balloon technique promises to become a standard method for diagnostic and therapeutic endoscopy of the small bowel without surgical laparotomy.
VOLUME 59, NO. 5, 2004
GASTROINTESTINAL ENDOSCOPY
P155