Success rate of retrograde double-balloon enteroscopy.
BACKGROUND
Retrograde double-balloon enteroscopy (rDBE) is technically a different procedure from its antegrade counterpart. Its unique indications, success rate, and learning curve have not been specifically reported.


OBJECTIVE
To examine technical issues specific to the rDBE approach.


METHODS
Retrospective review.


METHODS
Single tertiary-care center.


METHODS
All patients referred for rDBE.


METHODS
Procedure duration, technical success, learning curve, and complications related to rDBE.


RESULTS
A total of 59 rDBEs were performed on 56 patients for obscure GI bleeding (46.4%), metastatic carcinoids (23.2%), Crohn's disease (14.3%), and other indications. rDBE enabled a diagnosis in 47.5% of procedures and had a 38% diagnostic rate in finding primary small-bowel lesions that were responsible for metastatic carcinoids. The mean (standard deviation) total procedure time was 111.3 +/- 39.9 minutes. Procedure failure occurred in 12 cases (21%), which is significantly more than reported with antegrade procedures (2%). Failure was more common among patients with a prior abdominal or pelvic surgery (P = .001), and the time to achieve a stable ileal intubation was prolonged in these patients (13.9 vs 38.1 minutes; P = .0006). A trend was noted toward successful small-bowel access and increased lengths of small bowel examined after 20 procedures were performed.


CONCLUSIONS
Small retrospective study.


CONCLUSIONS
rDBE is effective for the evaluation and the treatment of lower small-intestinal lesions; however, maintaining access through the ileocecal valve may be difficult. Prior surgery may be an important factor associated with failure. A minimum of 20 rDBE procedures was needed to minimize procedure failure, examine a substantial segment of the small-bowel, and shorten procedure duration.
Mehdizadeh
Shahab
S
Department of Gastroenterology, Cedars-Sinai Medical Center, University of California, Los Angeles, School of Medicine, Los Angeles, CA 90048, USA.
Han
Nancy J
NJ
Cheng
Derek W
DW
Chen
Gary C
GC
Lo
Simon K
SK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome