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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Evaluation of the diagnostic and therapeutic utility of retrograde through-the-scope balloon enteroscopy and single-balloon enteroscopy
Yi Jia, Majd Michael, Mohammad Bashashati, Sherif Elhanafi, Christopher Dodoo, Alok K Dwivedi, Andres F Carrion, Mohamed O Othman, Marc J Zuckerman
Yi Jia, Majd Michael, Mohammad Bashashati, Sherif Elhanafi, Marc J Zuckerman, Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, United States
Christopher Dodoo, Alok K Dwivedi, Biostatistics and Epidemiology Consulting Lab, Office of Research Resources and Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, United States
Andres F Carrion, Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, Miami, FL 33136, United States
Mohamed O Othman, Department of Internal Medicine, Baylor College of Medicine, Houston, TX 77082, United States
Author contributions: Jia Y contributed to acquisition of data, analysis and interpretation of data, drafting the manuscript; Michael M, Bashashati M and Elhanafi S contributed to acquisition of data, analysis and interpretation of data and critical revision of the manuscript for important intellectual content; Dodoo C and Dwivedi AK contributed to statistical analysis; Carrion AF and Othman MO contributed to critical revision of the manuscript for important intellectual content; Zuckerman MJ contributed to study concept and design, acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content, study supervision and guarantor; all authors reviewed and approved the final submitted manuscript.
Institutional review board statement: The study was approved by the Texas Tech University Health Sciences Center Institutional Review Board (Approval Number. E14078).
Conflict-of-interest statement: The authors have nothing to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at [marc.zuckerman@ttuhsc.edu]. Consent was not obtained but the presented data are anonymized and risk of identification is low.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Marc J Zuckerman, MD, Professor, Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, 4800 Alberta Avenue, El Paso, TX 79912, United States. marc.zuckerman@ttuhsc.edu
Received: June 18, 2020
Peer-review started: June 18, 2020
First decision: September 11, 2020
Revised: September 26, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: November 16, 2020
Processing time: 150 Days and 13.9 Hours
BACKGROUND
Retrograde single balloon enteroscopy (SBE) is a minimally invasive procedure which is less frequently performed compared with antegrade SBE. There are few studies on the retrograde through–the-scope enteroscopy (TTSE), a novel technique for evaluation of the small bowel.
AIM
To compare the clinical utility and safety of retrograde TTSE with retrograde SBE.
METHODS
Clinical data and complications of retrograde TTSE (2014-2018) and retrograde SBE (2011-2018) performed in a community hospital were reviewed and presented as mean ± SD or frequency (%) and compared using proper statistical tests. Technical success was defined as insertion of the enteroscope > 20 cm beyond ileocecal valve.
RESULTS
Data obtained from 54 retrograde SBE in 49 patients and 27 retrograde TTSE in 26 patients were studied. The most common indication for retrograde enteroscopy was iron deficiency anemia (41 patients) followed by gastrointestinal bleeding (37 patients), and chronic diarrhea (7 patients). The duration of retrograde SBE procedure (91.9 ± 34.2 min) was significantly longer compared with retrograde TTSE (70.5 ± 30.7 min) (P = 0.04). Technical success was comparable in TTSE [23/27 (85.2%)] and SBE [41/54 (75.9%) (P = 0.33)]. The mean depth of insertion beyond the ileocecal valve in retrograde SBE (92.5 ± 70.0 cm) tended to be longer compared with retrograde TTSE (64.6 ± 49.0 cm) (P = 0.08). No complication was observed in this study.
CONCLUSION
Both retrograde TTSE and retrograde SBE are feasible and safe. Retrograde TTSE takes a shorter time and has a comparable technical success with SBE. TTSE has a lower capacity of small bowel insertion.
Core Tip: Retrograde single balloon enteroscopy (SBE) and retrograde through–the-scope enteroscopy (TTSE) are minimally invasive procedures with limited data available about their value in the management of small intestinal pathologies. This study compared the clinical utility and safety of retrograde TTSE with retrograde SBE and found them to be feasible and safe with a shorter procedure time for retrograde TTSE and a comparable technical success with SBE.
