Push-and-pull enteroscopy in the small bowel using the double-balloon technique: results of a prospective European multicenter study.
OBJECTIVE
The aim of this study was to evaluate the feasibility, safety, and clinical impact of push-and-pull enteroscopy (PPE) in patients with suspected or documented small-bowel diseases, in a prospective multicenter trial in three European medical centers.


METHODS
A total of 100 patients (mean age 56 +/- 16 years; range 13 - 90) were included at the three institutions between July and November 2004. The leading symptoms were: acute recurrent or chronic gastrointestinal bleeding (n = 64), polyposis syndrome (n = 8), chronic abdominal pain (n = 7), chronic diarrhea (n = 7), and others (n = 14).


RESULTS
No major PPE-associated complications such as perforation, bleeding, or relevant injury to the small-bowel tissue or mesentery were encountered. Minor complications occurred in 12 %. The mean time required to carry out the procedure from the oral and anal approaches was 75 +/- 19 min (32 - 150 min). The average insertion depths into the small bowel were 200 +/- 70 cm per PPE session (220 +/- 90 cm with the oral approach and 130 +/- 80 cm with the anal approach). The average radiation exposure (including diagnostic and therapeutic interventions) was 2.1 +/- 2.4 min and 155 +/- 159 dGy/cm2. PPE was fully diagnostic in 72 % of cases. The majority of the patients (34 %) were suffering from angiodysplasias; ulcerations and erosions of various etiologies were seen in 16 %, and polyps and tumors in 13 %. The PPE findings played a role in the subsequent treatment in 62 % of the patients. Endoscopic treatments, including argon plasma coagulation, polypectomy, dilation, and foreign-body extraction, were carried out in 42 %. Medical treatment was given in 12 %, and patients were referred for surgery in 8 % of cases.


CONCLUSIONS
This prospective analysis shows that PPE is safe and has a high diagnostic and therapeutic yield in patients with suspected or known small-bowel disease.
Ell
C
C
Dept. of Internal Medicine II, HSK Wiesbaden (Teaching Hospital of the University of Mainz), Wiesbaden, Germany. ell.hsk-wiesbaden@arcor.de
May
A
A
Nachbar
L
L
Cellier
C
C
Landi
B
B
di Caro
S
S
Gasbarrini
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016145:Endoscopy, Digestive System / Q000379:methods*; D005060:Europe; D005240:Feasibility Studies; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome