Brief Article
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World J Gastroenterol. Jan 7, 2010; 16(1): 56-62
Published online Jan 7, 2010. doi: 10.3748/wjg.v16.i1.56
Double balloon enteroscopy in children: Diagnosis, treatment, and safety
Mike Thomson, Krishnappa Venkatesh, Khalid Elmalik, Willam van der Veer, Maartan Jaacobs
Mike Thomson, Krishnappa Venkatesh, Khalid Elmalik, Centre for Paediatric Gastroenterology, Sheffield Children’s NHS Foundation Trust, Sheffield, S10 2TH, United Kingdom
Willam van der Veer, Maartan Jaacobs, Department of Gastroenterology, VU University Medical Center, Postbus 7057, 1007 MB, Amsterdam, The Netherlands
Author contributions: Thomson M and Jaacobs M designed research; Thomson M, Venkatesh K, van der Veer W and Jaacobs M performed research; Thomson M, Venkatesh K and Elmalik K wrote the paper.
Correspondence to: Dr. Mike Thomson, Centre for Paediatric Gastroenterology, Sheffield Children’s Hospital, Sheffield, S10 2TH, United Kingdom. mike.thomson@sch.nhs.uk
Telephone: +44-114-2717673 Fax: +44-114-2267659
Received: March 7, 2009
Revised: November 23, 2009
Accepted: November 30, 2009
Published online: January 7, 2010
Abstract

AIM: To assess the feasibility and utility of double balloon enteroscopy (DBE) in the management of small bowel diseases in children.

METHODS: Fourteen patients (10 males) with a median age of 12.9 years (range 8.1-16.7) underwent DBE; 5 for Peutz-Jeghers syndrome (PJ syndrome), 2 for chronic abdominal pain, 4 for obscure gastrointestinal (GI) bleeding, 2 with angiomatous malformations (1 blue rubber bleb nevus syndrome) having persistent GI bleeding, and 1 with Cowden’s syndrome with multiple polyps and previous intussusception. Eleven procedures were performed under general anesthesia and 3 with deep sedation.

RESULTS: The entire small bowel was examined in 6 patients, and a length between 200 cm and 320 cm distal to pylorus in the remaining 8. Seven patients had both antegrade (trans-oral) and retrograde (trans-anal and via ileostomy) examinations. One patient underwent DBE with planned laparoscopic assistance. The remaining 6 had trans-oral examination only. The median examination time was 118 min (range 95-195). No complications were encountered. Polyps were detected and successfully removed in all 5 patients with PJ syndrome, in a patient with tubulo-villous adenoma of the duodenum, in a patient with significant anemia and occult bleeding, and in a patient with Cowden’s syndrome. A diagnosis was made in a patient with multiple angiomata not amenable to endotherapy, and in 1 with a discrete angioma which was treated with argon plasma coagulation. The source of bleeding was identified in a further patient with varices. DBE was normal or revealed minor mucosal friability in the remaining 3 patients. Hence a diagnostic yield of 11/14 with therapeutic success in 9/14 was achieved.

CONCLUSION: Double balloon enteroscopy can be a useful diagnostic and therapeutic tool for small bowel disease in children, allowing endo-therapeutic intervention beyond the reach of the conventional endoscope.

Keywords: Double balloon enteroscopy; Gastrointestinal; Peutz Jeghers syndrome; Wireless video capsule endoscopy; Children