Double-balloon endoscopy for small intestinal disease: a single-center experience in Hungary

We report on our experience with the Fujinon EN-450 T5 therapeutic double-balloon endoscope (DBE) and compare our findings with the results of earlier capsule endoscopy.

Between August 2005 and July 2009, 150 DBE procedures were conducted in 139 consecutive patients (M/F: 67/72, age: 51.1 years, SD: 18.6 years) who presented at our tertiary referral hospital. The results of previous capsule endoscopy (CE) examinations were available in 27 patients. The indications for DBE included obscure gastrointestinal bleeding (OGIB) in 83 patients, suspected/known IBD in 25, and polyposis/suspected neoplasia in 29 patients. All of the examinations were performed at our outpatient clinic.

In OGIB, abnormal small-bowel findings were noted in 50 patients (60.2%) including angiodysplasias, erosions, and small ulcers. Malignancy was found in 6 patients (7.2%), while an intervention was carried out in 24 patients. In suspected IBD cases, IBD was diagnosed in 5/13 cases. In known IBD patients, assessment of the extent as well as disease behavior and activity was the indication. In polyposis/suspected malignancy, polyps were removed by snare polypectomy in 8 Peutz-Jeghers patients, while primary adenocarcinoma was diagnosed in 4. The concordance of CE and DBE findings was 51.8% (14/27), while in 2 cases DBE provided significantly new information, including 1 malignancy. The average insertion length was app. 213 cm (range: 70-480 cm).

Based on our experience, DBE is a safe and useful method for evaluating and treating small-bowel disease in selected patients with obscure bleeding, IBD or polyposis syndromes. The concordance of DBE and CE in this real-life setting was only fair.