title: Diagnostic and therapeutic utility of double-balloon enteroscopy in children.
abstract: OBJECTIVE
  Diagnostic and therapeutic benefits of double-balloon enteroscopy (DBE) have been documented in adults, with few data available on pediatric patients. We evaluated the diagnostic and therapeutic utility of DBE in children.
  
  
  METHODS
  A prospective assessment of 113 DBE procedures in 58 consecutive children younger than 18 years (36 boys, 22 girls; median age 12.7 years, range 1-18 years) was performed for a variety of suspected small bowel (SB) disorders from January 2008 to August 2012 in a tertiary referral center for pediatric patients. All of the children had undergone upper gastrointestinal endoscopy and ileocolonoscopy. A total of 19 patients had undergone radiological investigations for SB (n = 11 magnetic resonance imaging; n = 5 barium enterography; n = 3 computed tomography) and 54 patients had undergone wireless capsule endoscopy (WCE).
  
  
  RESULTS
  The overall median (range) examination time was 92.5 (45-275) minutes. The median (range) estimated insertion length of SB distal to pylorus was 230 (80-450) cm and proximal to ileocecal valve was 80 (5-275) cm. The common indications for DBE were polyposis syndromes (n = 21) and obscure gastrointestinal bleeding (n = 16). The findings included polyps (n = 19), mucosal ulcers and erosions (n = 8), submucosal elevations with white nodules (n = 4), and angioma/angiodysplasia (n = 2). The overall diagnostic yield for SB lesions using DBE was 70.7% (41/58) and for WCE was 77.7% (42/54). Endotherapeutic intervention was successfully used in 46.5% (n = 27/58). The endoscopic, medical, and surgical contributions to change in management by DBE were 72.4% (n = 42/58). Three complications (5.2%) were noted with uneventful recovery.
  
  
  CONCLUSIONS
  The diagnostic yield of DBE was comparable to WCE, but with the addition of therapeutic possibility and histological yield. We believe this technique could be a valuable addition to existing endoscopic techniques, complementary to WCE, and may be considered as an alternative diagnostic and therapeutic option in the SB in children.
authors.affiliation: *Centre for Paediatric Gastroenterology and International Academy of Pediatric Endoscopy Training, Sheffield Children's NHS Foundation Trust, Sheffield, UK †Department of Paediatrics, University of Naples "Federico II," Naples, Italy.
authors.forename: Arun N
authors.initials: AN
authors.lastname: Urs
authors.forename: Massimo
authors.initials: M
authors.lastname: Martinelli
authors.forename: Prithviraj
authors.initials: P
authors.lastname: Rao
authors.forename: Mike A
authors.initials: MA
authors.lastname: Thomson
mesh_terms: D000293:Adolescent; D016888:Angiodysplasia / Q000473:pathology; D053704:Capsule Endoscopy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D058582:Double-Balloon Enteroscopy / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000601:surgery; D006391:Hemangioma / Q000473:pathology; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000175:diagnosis / Q000601:surgery; D007413:Intestinal Mucosa / Q000473:pathology; D007414:Intestinal Neoplasms / Q000473:pathology; D044483:Intestinal Polyposis / Q000175:diagnosis / Q000601:surgery; D007421:Intestine, Small / Q000601:surgery*; D008297:Male; D011446:Prospective Studies