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WHAT ARE THE INDICTIONS FOR DOUBLE BALLOON ENDOSCOPY?: A SYSTEMATIC REVIEW
CJ Green1, SJ Heitman2, S vanZanten1, L Chan
1University of Alberta, Edmonton; 2University of Calgary, Calgary, Alberta
BACKGROUND: As double-balloon endoscopy (DBE) becomes increasingly available in Canada, users of the technology will need to be aware of its indications. Given a lack of comparative trials, large consecutive case series may provide the best reflection of current mature practice.
METHODS: We conducted a systematic review of large consecutive case series (> 200 cases) of diagnosis, safety and treatment of small intestinal disorders using DBE published in the English language from 2001 to October 2007. Major electronic databases used include: Cochrane Library, PubMed, CRD Databases and EMBASE.
RESULTS: Our search revealed 573 citations including 5 large case series reporting on 1481 cases (Choi et al., 2007; Heine et al., 2006; Kita et al., 2007; May et al., 2007; Zhong et al., 2007) along with one multi-centre survey of complication rates (Mensink et all, 2007). Obscure gastrointestinal bleeding (OGIB) represents 56% (range 49 to 61%) of all DBE indications. In one study, chronic abdominal pain (10%), polyposis syndromes (9%), Crohn’s disease (8%) and other (13%) were the primary non-OGIB indications. Another study categorized non-OGIB as obstructive symptoms in 22% and suspicion of intestinal tumours in 8%.
A post-polypetectomy bleeding rate of 10.8% was reported by May et al, 2007. This is contradicted by the pooled multi-centre survey, which reported an overall post-polypectomy bleeding rate of 3.3% with no major and 7 (1.9%) moderate complications. The overall rate of serious complications is 0.8% including pancreatitis and perforations. Health outcome data is largely limited to procedural success.
CONCLUSION: The available large case series provide observational data describing how early adopters of the technology are currently using DBE. The potential indications for the procedure are broad, but OGIB remains the most common. Large prospective studies evaluating the effectiveness and safety of DBE are needed to establish this technique for diagnosing and treating small bowel disorders. Studies are also needed to comparing DBE to other modalities such as capsule endoscopy.