title: Double balloon enteroscopy can be safely done in elderly patients with significant co-morbidities.
abstract: OBJECTIVE
  Performance of double balloon enteroscopy (DBE) on older patients with comorbidities is a matter of safety. We aimed to investigate the utility and safety of DBE in older patients.
  
  
  METHODS
  We retrospectively reviewed the medical records of patients 75 years or older who underwent DBE in our open-access endoscopy unit in a tertiary center. We analyzed the diagnostic yield, therapeutic intervention, and safety including complications of DBE.
  
  
  RESULTS
  Four scheduled DBEs were canceled because of poor conditions. Two hundred and fourteen DBEs were performed in 167 elderly patients. All DBEs were performed under monitored anesthesia care using intravenous propofol administered by anesthesiologists. One half of the patients were male (female : male = 80:87). The mean age of patients was 80.1 ± 3.7 years. Co-morbidity of significant chronic diseases was noted in 208 (97.2%) DBEs. Fifty-one (23.8%) DBEs were performed in patients with American Society of Anesthesiologists (ASA) physical status II, 151 (70.6%) DBEs with ASA class III, and 12 (5.6%) DBEs with ASA class IV. The most common indication was obscure gastrointestinal bleeding. The mean DBE procedure time was 131 ± 51 min. Abnormalities were detected in 129 (60.3%) DBEs with therapeutic interventions performed in 83 (38.8%) cases. Pancreatitis, hypoxia, and aspiration pneumonia developed after three (1.4%), three (1.4%), and two (0.9%) DBEs, respectively, all of which resolved with conservative care.
  
  
  CONCLUSIONS
  Double balloon enteroscopy can be done with acceptable safety in the elderly with high ASA class. DBE shows a high diagnostic yield and can deliver many therapeutic applications.
authors.affiliation: David Geffen School of Medicine at UCLA, Cedars-Sinai Medical Center, Los Angeles, California, USA. jsbyeon@amc.seoul.kr
authors.forename: Jeong-Sik
authors.initials: JS
authors.lastname: Byeon
authors.forename: Neel K
authors.initials: NK
authors.lastname: Mann
authors.forename: Laith H
authors.initials: LH
authors.lastname: Jamil
authors.forename: Simon K
authors.initials: SK
authors.lastname: Lo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000771:Anesthesia, Intravenous; D002908:Chronic Disease; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D058582:Double-Balloon Enteroscopy / Q000009:adverse effects; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007421:Intestine, Small; D008297:Male; D012189:Retrospective Studies; D012449:Safety