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INDICATIONS AND DIAGNOSTIC YIELD OF DOUBLE-BALLOON ENDOSCOPY PERFORMED AT A CANADIAN TERTIARY CARE CENTRE
G Chami, V Webbink, J Love, C Dube, R Hilsden, S Heitman
University of Calgary, Calgary, Alberta
Aims: Double-balloon endoscopy (DBE) has been a major advance in evaluating patients with disorders of the small bowel. Although there are many published studies on DBE, Canadian data are limited. The purpose of this study is to review the initial experience of DBE performed at our centre.
Methods: The University of Calgary acquired DBE in February 2008. All DBEs performed between February and October 2008 were retrospectively reviewed. Information including patient demographics, procedure type and indication, diagnoses, therapeutic interventions, depth of insertion, and immediate complications was extracted from the procedure report and the patient's hospital chart.
Results: 50 DBEs were performed by 2 gastroenterologists on 37 patients (34% male). 13 patients had more than one DBE performed. The mean age was 52.6 years (SD 14.3). 23 procedures (46%) were antegrade, 20 (42%) were retrograde, and 6 (14%) were double-balloon colonoscopies. All of the double-balloon colonoscopies were performed on patients with previously failed colonoscopies. The cecum was reached in all 6 cases. The main indications for the 44 DBEs performed on the small bowel were: abnormal capsule endoscopy (48%), obscure-overt gastrointestinal bleeding (18%), known or suspected Crohn's disease (16%), abnormal radiographic imaging (11%), and other (7%). 49 cases were performed under conscious sedation (98%). The average depth of insertion for antegrade (beyond Treitz) and retrograde (proximal to ileocecal valve) was 203.5 cm (SD 78.1) and 72.6 cm (SD 63.9), respectively and the average procedure time was 57.8 min (SD 19.2) and 58.4 min (SD 22.6), respectively. Clinically relevant findings were observed in 31 of the 50 DBEs (64%). Clinically relevant findings within the small intestine were found in 20 of the 44 small bowel DBEs (45%). There were complications in 4 cases (8%); 2 patients experienced oxygen desaturation (one was transient and the other required intubation) and 2 patients required admission to hospital (one for pain, the other for observation post-polypectomy).
Conclusions: We have shown that DBE can be performed safely and efficiently with high diagnostic yield. Further prospective data is required to determine its overall clinical impact and cost-effectiveness.