Clinical Analysis Of 137 Cases Of Double Balloon Enteroscopy

Background: Double balloon enteroscopy(DBE)has become widely accepted for the diagnosis and treatment of small bowel diseases(SBDs).Its diagnostic and therapeutic yield is higher than other modalities used for the diagnosis and treatment of SBDs.However,skilled gastroenterologist with special training in DBE is needed to obtain better diagnostic and therapeutic efficacy.Objective: To analyze the indications,diagnostic yields of DBE,compare results of DBE alone and DBE with prior capsule endoscopy(CE)and therapeutic yields of DBE in suspected small bowel diseases(SBDs).Methods: A single center retrospective study was performed in Southeast University affiliated Zhongda Hospital.Hospital database were used to gather the information about the diseases and procedures.A total of 137 patients underwent Double Balloon Enteroscopy were enrolled in the study.All the patients admitted in the center during three-year period from January 2015 to December 2017 who were suspected as SBDs who underwent DBE and CE in combination with DBE were taken as a sample population for this study.SPSS version 20 was used for all statistical analysis.Crosstabulation and Chi square test and Fisher’s exact test were used to determine the level of significance and to find the relationship between variables in the study area.Results: Over a period of 3 years,137 consecutive DBE procedures were performed in our hospital,60 cases(44%)went DBE via anal route(retrograde)while 55 cases(40%)underwent DBE via oral route(antegrdae)and 22 cases(16%)underwent DBE via both oral and anal route.No failed procedures documented.Most common indications were found to be pain abdomen followed by OGIB,suspected small bowel inflammation in radiological imaging,suspected inflammatory bowel disease(IBD),diarrhea and suspected mass/tumors.Most common findings of DBE was crohn’s disease(CD)followed by ulcer,inflammatory conditions and polyps.The overall diagnostic yield of DBE was found to be 81% and the positive detection rate was higher in pain abdomen(83%)followed by obscure gastrointestinal bleeding(OGIB)(78%)and suspected IBD(68%).Therapeutic yield of DBE was found to be 8.75%.No major complications were recorded in diagnostic as well as therapeutic intervention.9 cases underwent CE prior to DBE,with positive detection rate of CE being 55.6%.DBE was later performed to all those 9 cases for the confirmation of the findings and the positive detection rate of those 9 cases with DBE was 100%.Diagnostic yield of DBE alone in 128 cases was found to be positive in 102 patients with 79.7% positive detection rate.Limitations: Since this study was a single-center analysis and conducted in one center,samples does not represent the overall population and the results might not be applicable to general population.Sample size of the study was also small so the study needs further research with larger sample size for more conclusive results.Conclusion: From this study we found that pain abdomen,OGIB,suspected small bowel inflammation and suspected IBD were the most common indications of DBE.Our study showed that the diagnostic yield of DBE was found to be high with no major complications which marks it as a safer procedure.Crohn’s disease,ulcer and inflammatory conditions respectively were the most common findings in our retrospective study.This study also demonstrated that DBE with prior CE had very high diagnostic rate,but due to very less number of cases we couldn’t conclude that DBE with prior CE has overall high positive detection rate and suggest further studies in future.So,we concluded that DBE with its high diagnostic yield,therapeuticcapability,periprocedural and post procedural safety makes it the choice of intervention and should always be considered an important modality in the diagnosis and treatment of SBDs.