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Diagnostic and therapeutic utility of double-balloon enteroscopy in children
Arun N Urs1, Massimo Martinelli, Prithviraj Rao
1*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.
Insights
Double-balloon enteroscopy (DBE) offers comparable diagnostic yield to wireless capsule endoscopy (WCE) in children. This pediatric enteroscopy provides therapeutic intervention and histological diagnosis for small bowel disorders.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Endoscopy
- Small Bowel Disorders
Background:
- Double-balloon enteroscopy (DBE) is established for diagnostic and therapeutic benefits in adults.
- Limited data exist on the utility of DBE in pediatric populations.
- Previous investigations like upper endoscopy, colonoscopy, radiology, and WCE were often insufficient for small bowel evaluation.
Purpose of the Study:
- To evaluate the diagnostic and therapeutic utility of double-balloon enteroscopy (DBE) in children.
- To assess DBE's role in diagnosing various suspected small bowel (SB) disorders in pediatric patients.
- To compare DBE's diagnostic yield with wireless capsule endoscopy (WCE).
Main Methods:
- Prospective assessment of 113 DBE procedures in 58 consecutive children (<18 years) with suspected SB disorders.
- Procedures performed between January 2008 and August 2012 at a tertiary pediatric referral center.
- Patients had prior upper GI endoscopy and ileocolonoscopy; some had prior radiology or WCE.
Main Results:
- Common indications included polyposis syndromes (21) and obscure gastrointestinal bleeding (16).
- DBE identified polyps (19), ulcers/erosions (8), and vascular lesions (2).
- Overall diagnostic yield for SB lesions was 70.7% (DBE) vs. 77.7% (WCE); therapeutic intervention was successful in 46.5% of DBE cases, changing management in 72.4%.
Conclusions:
- DBE demonstrated a diagnostic yield comparable to WCE in children.
- DBE offers the advantage of therapeutic intervention and histological sample acquisition.
- DBE is a valuable endoscopic tool for pediatric small bowel evaluation, complementary to WCE.
Objectives:
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.
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