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Push-and-pull enteroscopy using the double-balloon technique/double-balloon enteroscopy
1Department of Medicine II, HSK, Klinikum Wiesbaden, Ludwig Erhardt Strasse 100, 65199 Wiesbaden, Germany.
Abstract:
Push-and-Pull enteroscopy/Double balloon enteroscopy (PPE/DBE) allows enteroscopy of the entire small bowel, or at least a substantial part of it. The complication rate is acceptably low. Severe complications such as pancreatitis and perforation were encountered in the literature in approximately 1% of all diagnostic PPE/DBEs. It can be expected that the complication rate of therapeutic PPE/DBEs is higher, comparable with the conventional endoscopy. The diagnostic yield is high, at approximately 75%, as is the therapeutic yield. The option of carrying out endoscopic therapy (in approximately 40%-50% of cases in the Western hemisphere) is an important aspect. Angiodysplasias are the main bleeding source, at least in Western countries. Using the PPE/DBE device, endoscopic treatments such as endoscopic hemostasis using injection and argon plasma coagulation, polypectomy, endoscopic resection, balloon dilation, and foreign-body extraction have become feasible even in the small intestine and can generally be performed safely and without relevant technical problems. Medical therapy can be started in up to 20% of cases-e.g., after a new or changed diagnosis of Crohn's disease. Surgical therapy is required in 10-20% of cases, due to malignant tumors or complex stenoses, for example. The main indication is mid-gastrointestinal bleeding.
Insights
Push-and-Pull enteroscopy (PPE/DBE) offers high diagnostic and therapeutic yields for small bowel evaluation. This minimally invasive technique enables effective treatments for conditions like angiodysplasias, with a low complication rate.
Area of Science:
- Gastroenterology
- Endoscopy
Background:
- The small intestine presents diagnostic and therapeutic challenges due to its length and inaccessibility.
- Push-and-Pull enteroscopy/Double balloon enteroscopy (PPE/DBE) has emerged as a key technology for visualizing and intervening within the small bowel.
Purpose of the Study:
- To evaluate the diagnostic and therapeutic efficacy of PPE/DBE.
- To assess the complication rates associated with PPE/DBE procedures.
- To review the main indications and outcomes of PPE/DBE.
Main Methods:
- Review of literature on diagnostic and therapeutic Push-and-Pull enteroscopy/Double balloon enteroscopy (PPE/DBE).
- Analysis of complication rates, diagnostic yield, and therapeutic applications.
- Identification of common indications and treatment modalities.
Main Results:
- PPE/DBE provides high diagnostic yields (approx. 75%) and therapeutic capabilities (approx. 40%-50%).
- Severe complications like pancreatitis and perforation occur in about 1% of diagnostic procedures.
- Endoscopic therapies including hemostasis, polypectomy, and dilation are feasible and safe.
- Mid-gastrointestinal bleeding, particularly from angiodysplasias, is a primary indication.
Conclusions:
- PPE/DBE is a safe and effective tool for diagnosing and treating small bowel pathologies.
- The procedure facilitates endoscopic interventions, reducing the need for surgery in many cases.
- PPE/DBE significantly improves management of mid-gastrointestinal bleeding and other small bowel diseases.
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