Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Aug 10, 2016; 8(15): 501-507
Published online Aug 10, 2016. doi: 10.4253/wjge.v8.i15.501
Performance characteristics of retrograde single-balloon endoscopy: A single center experience
Kaci E Christian, Karan Kapoor, Eric M Goldberg
Kaci E Christian, Karan Kapoor, Eric M Goldberg, Department of Medicine, Division of Gastroenterology, University of Maryland Medical Center, Batimore, MD 21201, United States
Author contributions: Christian KE, Kapoor K and Goldberg EM contributed equally to this work; Christian KE collected and analyzed the data and drafted the manuscript; Kapoor K analyzed the data and assisted with drafting the manuscript; Goldberg EM designed and supervised the study.
Institutional review board statement: This study was reviewed and approved by the University of Maryland Medical Center Institutional Review Board. Please see the attached document.
Informed consent statement: All study participants, or their legal guardian, provided informed consent (written or verbal, as appropriate) prior to undergoing the procedures retrospectively described in this study.
Conflict-of-interest statement: Christian, KE and Kapoor K have no conflicts of interest to report. Goldberg EM has served as a consultant for both Olympus and Boston Scientific. Please see the attached signed document.
Data sharing statement: No additional data are available. Please see the attached signed document.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Kaci E Christian, MD, Department of Medicine, Division of Gastroenterology, University of Maryland Medical Center, 21 South Greene Street, Batimore, MD 21201, United States. kchristian1@medicine.maryland.edu
Telephone: +1-570-3282370 Fax: +1-410-3282977
Received: September 22, 2015
Peer-review started: October 3, 2015
First decision: December 28, 2015
Revised: April 6, 2016
Accepted: May 7, 2016
Article in press: May 9, 2016
Published online: August 10, 2016
Processing time: 318 Days and 11.1 Hours
Abstract

AIM: To evaluate the technical success, diagnostic yield (DY) and therapeutic potential of retrograde single balloon enteroscopy (rSBE).

METHODS: A retrospective review of 136 rSBE procedures performed at a tertiary academic referral center from January 2006 and September 2013 was completed. Patient characteristics including age, gender and inpatient status were collected. The indication for the procedure was categorized into one of three groups: Obscure gastrointestinal bleeding (GIB), evaluation for Crohn’s disease and abnormal imaging. Procedural characteristics including insertion depth (ID), procedure time, concordance with pre-procedural imaging and complications were also recorded. Lastly, DY, defined as the percentage of cases producing either a definitive diagnosis or findings that could explain clinical symptoms and therapeutic yield (TY), defined as the percentage of cases in which a definitive intervention was performed, were determined. Mucosal tattooing and biopsy alone were not included in the TY.

RESULTS: A total of 136 rSBE procedures were identified. Mean patient age was 57.5 (± 16.2) years, 67 (49.2%) were male, and 110 (80.9%) procedures were performed on an outpatient basis. Indications for rSBE included GIB in 55 (40.4%), evaluation of inflammatory bowel disease (IBD) in 29 (21.3%), and imaging suggestive of pathology other than GIB or IBD in 43 (31.6%). Nine (6.6%) rSBEs were performed for other indications. Mean ID was 68.3 (± 39.3) cm proximal to the ileocecal valve and mean time to completion was 41.7 (± 15.5) min. Overall, 73 (53.7%) cases were diagnostic and 25 (18.4%) cases were therapeutic in which interventions (argon plasma coagulation, stricture dilatation, polypectomy, etc.) were performed. Pre-procedural imaging was performed in 88 (64.7%) patients. Endoscopic concordance of positive imaging findings was seen in 31 (35.2%) cases. Follow up data was available in 93 (68.4%) patients; 2 (2.2%) reported post-procedural abdominal pain within 30 d following rSBE. There were no other reported complications.

CONCLUSION: rSBE exhibits an acceptable diagnostic and TY, rendering it a safe and effective procedure for the evaluation and treatment of small bowel diseases.

Keywords: Retrograde; Single-balloon; Enteroscopy; Endoscopy

Core tip: Disorders of the small intestine account for an increasing number of hospital discharges and aggregate healthcare cost. Single-balloon enteroscopy (SBE) represents a novel approach to diagnose and treat small bowel disease and can be performed via the antegrade or retrograde approach. SBE has different performance characteristics depending upon the route chosen, but most studies combine the information. Little data exists on the retrograde approach alone, a notoriously difficult procedure. This study constitutes the largest published cohort to date of retrograde SBE, with a focus on patient and procedural characteristics, diagnostic and therapeutic yield.