Double balloon enteroscopy in children: Diagnosis, treatment, and safety

Table 1 Investigations performed on patients prior to DBE

1	WCE: ?small sessile polyp in mid-small bowel
2	Intra-operative enteroscopy with polypectomy
	MRI enteroclysis: normal
3	OGD: polyps in stomach and duodenum
	MRI: 3 big polyps in small bowel
4	WCE: multiple polyps in mid-small bowel
5	WCE: possible polyp in ileum
6	WCE: ?polyps seen in small bowel, ?intermittent intussusception Colonoscopy: polyp in rectum
7	WCE: normal, Abdominal Ultrasound: enlarged spleen
8	WCE: no source of bleeding
9	OGD, WCE: lymphonodular hyperplasia in duodenum of little clinical significance
10	OGD, WCE: no positive findings
11	OGD, Ileo-colonoscopy, WCE: multiple blue rubber bleb nevus lesions throughout bowel
12	WCE: angioma in small bowel
13	WCE: polyp in mid-small bowel
14	WCE: multiple polyps seen throughout the small bowel including a lymphangitic polyp

DBE: Double balloon enteroscopy; WCE: Wireless video capsule endoscopy; OGD: Gastroduodenoscopy.

Table 2 Details of indications, approach and findings in patients undergoing DBE

Patient No.	Age/Sex	Indication	Approach	Complete /incomplete	Findings
1	13/M	PJS	Oral + anal	Complete	Rectal polyp
2	12/M	PJS	Oral	320 cm1	Small polyp in jejunum
3	16/M	PJS	Intra-operative	Complete	3 small polyps removed endoscopically and 3 large polyps removed surgically
4	11/M	PJS	Oral	250 cm1	Multiple polyps in mid-small bowel
5	9/M	PJS	Oral	Incomplete	Mid-small bowel polyp
6	10/F	Chronic abdominal pain	Oral + anal	Up to 200 cm1 trans-orally, 35 cm TI proximal to ICV trans-anally	Normal
7	16/M	Chronic abdominal pain with family history of colorectal carcinoma	Oral + anal	Complete	Tubulo-villous adenoma in duodenum; Lymphoid aggregates in ileum
8	11/M	Upper GI bleeds/possible vascular malformation	Oral	300 cm1	Grade 1 esophageal varices; no source found in small bowel
9	16/M	Occult bleeding	Oral	200 cm1	No source found
10	8/M	Occult bleeding	Oral + via ileal stoma	Complete	Increased friable mucosa throughout the small bowel
11	12/F	Blue rubber bleb syndrome with persistant GI bleeding	Oral + anal	2001 cm trans-orally, 50 cm proximal to ICV trans-anally	Numerous angiomas throughout small bowel not amenable to therapy
12	9/F	Angioma	Oral	Incomplete	Angioma identified: APC applied
13	16/M	Occult bleeding with significant anemia	Oral + anal	Complete	Polyp 40 cm from TI: removed
14	12/F	Cowden’s syndrome	Oral + anal	Complete	Multiple polyps: 2 snare polypectomies; Meckel’s diverticulum found

¹Post-pylorus distance achieved. PJS: Peutz-Jeghers syndrome; ICV: Ileo-caecal valve; APC: Argon plasma coagulation.