title: Double balloon enteroscopy in children: diagnosis, treatment, and safety.
abstract: OBJECTIVE
  To assess the feasibility and utility of double balloon enteroscopy (DBE) in the management of small bowel diseases in children.
  
  
  METHODS
  Fourteen patients (10 males) with a median age of 12.9 years (range 8.1-16.7) underwent DBE; 5 for Peutz-Jeghers syndrome (PJ syndrome), 2 for chronic abdominal pain, 4 for obscure gastrointestinal (GI) bleeding, 2 with angiomatous malformations (1 blue rubber bleb nevus syndrome) having persistent GI bleeding, and 1 with Cowden's syndrome with multiple polyps and previous intussusception. Eleven procedures were performed under general anesthesia and 3 with deep sedation.
  
  
  RESULTS
  The entire small bowel was examined in 6 patients, and a length between 200 cm and 320 cm distal to pylorus in the remaining 8. Seven patients had both antegrade (trans-oral) and retrograde (trans-anal and via ileostomy) examinations. One patient underwent DBE with planned laparoscopic assistance. The remaining 6 had trans-oral examination only. The median examination time was 118 min (range 95-195). No complications were encountered. Polyps were detected and successfully removed in all 5 patients with PJ syndrome, in a patient with tubulo-villous adenoma of the duodenum, in a patient with significant anemia and occult bleeding, and in a patient with Cowden's syndrome. A diagnosis was made in a patient with multiple angiomata not amenable to endotherapy, and in 1 with a discrete angioma which was treated with argon plasma coagulation. The source of bleeding was identified in a further patient with varices. DBE was normal or revealed minor mucosal friability in the remaining 3 patients. Hence a diagnostic yield of 11/14 with therapeutic success in 9/14 was achieved.
  
  
  CONCLUSIONS
  Double balloon enteroscopy can be a useful diagnostic and therapeutic tool for small bowel disease in children, allowing endo-therapeutic intervention beyond the reach of the conventional endoscope.
authors.affiliation: Centre for Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, S10 2TH, United Kingdom. mike.thomson@sch.nhs.uk
authors.forename: Mike
authors.initials: M
authors.lastname: Thomson
authors.forename: Krishnappa
authors.initials: K
authors.lastname: Venkatesh
authors.forename: Khalid
authors.initials: K
authors.lastname: Elmalik
authors.forename: Willam
authors.initials: W
authors.lastname: van der Veer
authors.forename: Maartan
authors.initials: M
authors.lastname: Jaacobs
mesh_terms: D000293:Adolescent; D000768:Anesthesia, General; D053704:Capsule Endoscopy; D002648:Child; D054810:Deep Sedation; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000628:therapy*; D007421:Intestine, Small / Q000473:pathology*; D010535:Laparoscopy; D008297:Male; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D014741:Video Recording