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The diagnostic and treatment values of double-balloon enteroscopy in children's Meckel's diverticular bleeding
Zhongsheng Zhu1, Shaoming Zhou, Huabo Cai
1Department of Gastroenterology, Shenzhen Children's Hospital, Shenzhen city, Guangdong Province, China.
Insights
Double-balloon enteroscopy (DBE) is a safe and effective diagnostic tool for identifying Meckel
Area of Science:
- Pediatric Gastroenterology
- Surgical Diagnostics
- Gastrointestinal Endoscopy
Background:
- Meckel's diverticula (MD) are a common congenital anomaly that can cause significant gastrointestinal bleeding in children.
- Accurate preoperative diagnosis is crucial for effective surgical management and to minimize complications.
- Traditional diagnostic methods may have limitations in visualizing small bowel lesions.
Purpose of the Study:
- To evaluate the diagnostic and treatment value of preoperative double-balloon enteroscopy (DBE) for Meckel's diverticula (MD) bleeding in children.
- To assess the safety and efficacy of DBE in identifying the source of bleeding in pediatric MD cases.
- To compare DBE findings with intraoperative observations and postoperative pathological results.
Main Methods:
- Retrospective analysis of clinical data from 10 pediatric patients with MD bleeding.
- All patients underwent preoperative DBE via an anal route.
- DBE results were compared with intraoperative findings and histopathological confirmation.
Main Results:
- DBE achieved a 100% success rate in all 10 pediatric patients, with no observed complications.
- DBE accurately diagnosed MD in all cases, identifying bleeding lesions and their location.
- Pathological examination confirmed MD with ectopic gastric mucosa in 90% of patients.
Conclusions:
- Preoperative DBE is a safe and reliable method for diagnosing Meckel's diverticula bleeding in children.
- DBE provides valuable guidance for surgical treatment by accurately locating the bleeding source.
- The diagnostic accuracy of DBE is comparable to surgical findings, enhancing preoperative planning.
Abstract:
The diagnostic and treatment values and safety of preoperative double-balloon enteroscopy (DBE) for Meckel's diverticula (MD) bleeding in children by retrospective review and analyses.The clinical data were collected and analyzed from 10 cases of children with MD receiving preoperative DBE examination and postoperative pathological confirmation. The diagnostic and treatment values and safety were assessed through the comparison of the DBE results and intra-operative observations and subsequently postoperative pathological results.Total cases are 10, 7 males and 3 females. The male to female ratio is 2.3 to 1. The youngest patient is 3.3 years old and oldest 12.1, the average age is 7.4 ± 3.0. The lowest body weight is 12.6 kg and the average is 32.5 ± 18.9 kg. The hematochezia was the main clinical manifestation in all patients with anemia and moderate to severe anemia were common (9/10, 90%). All patients had and tolerated the DBE procedures via anal route with 100% success rate. There were no observable complications during the examinations and post operations. All patients were diagnosed with MD by DBE. Exploratory laparoscopy and surgical operations were subsequently performed. All surgical samples were confirmed by pathology as bleeding MD. The postoperative follow-ups up to April 2019 (from 3 to 12 months) do not show any bleeding sign. Pathological examinations found ectopic gastric mucosa in 9 patients (90%) and one case had both ectopic gastric mucosa pancreatic tissue (10%). The distance of MD to ileocecal valve was from 60 to 100 cm (average 81.0 ± 16.0 cm) by DBE examinations. Surgery showed similar findings from 30 to 100 cm (average 71.0 ± 18.5) consistently to DBE. There is no statistical significance between 2 methods (Ζ = 1.715, Ρ = .086).DBE examination proves to be a safe method for diagnosing children's MD disease and can reliably determine the bleeding lesions in children's MD, providing valuable guidance for surgical treatment of children's MD bleeding.
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