RESUMEN
BACKGROUND: Few reports have focused on single-balloon enteroscopy (SBE) for evaluation of small bowel Crohn disease (CD) strictures. The aim of this study was to analyze the relationships between peripheral blood inflammatory markers and small bowel CD strictures observed by SBE. MATERIALS AND METHODS: CD patients who underwent SBE between January 2016 and December 2020 were enrolled. The clinical characteristics and peripheral blood inflammatory markers were collected and analyzed to screen for predictive factors significantly associated with small bowel CD strictures. RESULTS: A total of 221 CD patients underwent SBE. The lymphocyte (LC) counts in peripheral blood were significantly lower in the active group (n=178) than in the inactive group (n=43) according to the simple endoscopic score for CD (SES-CD), P =0.011, and was correlated with the SES-CD ( r =-0.134, P =0.047). The LC levels were significantly lower in the stricture group (n=116) than in the nonstricture group (n=105) based on whether small bowel strictures developed, P =0.000, and LC was a risk factor for strictures in the multivariate analysis [hazard ratio (HR), 2.332; 95% CI, 1.102-4.937; P =0.027]. In the subgroup analysis, LC levels notably decreased after stricture aggravation ( P =0.000). Forty-seven patients who underwent small bowel resection underwent SBE at 6 to 12 months after surgery. The LC level was significantly lower in the postoperative patients with strictures ( P =0.025), and LC (HR, 4.444; 95% CI, 1.265-15.617; P =0.020) was a risk of postoperative strictures by univariate analysis, but the age at diagnosis (HR, 6.462; 95% CI, 1.272-22.560; P =0.022) was an independent risk factor by multivariate analysis. CONCLUSION: Peripheral blood LC levels were correlated with SES-CD and gradually decreased as the intestinal stricture increased in small bowel CD patients. The LC level was also significantly lower in the postoperative CD patients with strictures. The level of LC was a risk factor for small bowel strictures. These results suggest that peripheral blood LC could be a novel marker of small bowel CD strictures to guide CD diagnosis and therapy.
Asunto(s)
Enfermedad de Crohn , Obstrucción Intestinal , Enteroscopia de Balón Individual , Humanos , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/cirugía , Enteroscopia de Balón Individual/efectos adversos , Constricción Patológica/etiología , Constricción Patológica/cirugía , Obstrucción Intestinal/cirugía , Factores de Riesgo , Linfocitos , Estudios RetrospectivosRESUMEN
BACKGROUND: Endoscopic access to the targeted site is a major challenge for the endoscopic retrograde cholangiopancreatography (ERCP) in patients undergoing Roux-en-Y (R-Y) reconstruction after total or subtotal gastrectomy. We aimed to evaluate the feasibility, reproducibility, and safety of mechanistic loop resolution strategies using a short-type single-balloon enteroscopy (short SBE) system. METHODS: Between February 2020 and March 2022, consecutive patients with a previous R-Y gastrectomy requiring ERCP were prospectively enrolled. Different mechanistic loop resolution strategies for two-dimensional loops, three-dimensionally rotated loops, and loops making a cane or S-shape were applied during the SBE approach. RESULTS: Forty-three short SBE-ERCP procedures were performed on 37 patients, with an approach success rate of 100.0% (43/43). The mean time to reach the jejunojejunal anastomosis and target site were 8.0 (6.0-11.0) minutes and 26.0 (16.0-36.0) minutes, respectively. The major challenges for the approach were the cane or S-shaped loop in the jejunojejunal anastomosis or Treitz ligament. The retroflex positioning of a SBE in front of the papilla was achieved in 86.0% (37/43), and the cannulation success rate in patients with an intact papilla was 90.9% (30/33). The initial, overall therapeutic successes, median total procedure time, and adverse event rate were 87.8%, 92.7%, 77.0 (IQR 56-100.5) minutes, and 11.6%, respectively. CONCLUSIONS: Short SBE-ERCP using standardized mechanistic loop resolution strategies is effective and reproducible in patients with R-Y reconstruction after gastrectomy. TRIAL REGISTRATION: ClinicalTrial.gov (NCT04847167).
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Colangiopancreatografia Retrógrada Endoscópica , Enteroscopia de Balón Individual , Humanos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Enteroscopia de Balón Individual/efectos adversos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Resultado del Tratamiento , Anastomosis en-Y de Roux/métodos , Gastrectomía/métodosAsunto(s)
Balón Gástrico , Enfermedades Intestinales , Obstrucción Intestinal , Enteroscopia de Balón Individual , Humanos , Enteroscopia de Balón Individual/efectos adversos , Balón Gástrico/efectos adversos , Intestino Delgado , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Enteroscopía de Doble Balón/efectos adversosAsunto(s)
Colangiopancreatografia Retrógrada Endoscópica , Enteroscopia de Balón Individual , Cateterismo/efectos adversos , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Humanos , Conductos Pancreáticos , Vena Porta/diagnóstico por imagen , Enteroscopia de Balón Individual/efectos adversosRESUMEN
BACKGROUND: Device-assisted enteroscopy including single-balloon enteroscopy (SBE) allows direct visualization of the small bowel and has good safety and efficacy in experienced hands. Our study is aimed to share our single-centre experience of SBE in diagnosing and treating small-bowel disorders. METHODS: We reviewed the prospectively collected data (from December 2016 to December 2019) of 180 consecutive anterograde and/or retrograde procedures. Analysis of baseline characteristics, endoscopic findings, and diagnostic and therapeutic rates was done. RESULTS: SBE was done in 158 patients with a median age of 55 years (range, 13-94 years) for suspected small-bowel lesions. Dual enteroscopy (anterograde plus retrograde) was done in 22 patients (13.92%). The indication for the procedure was obscure gastrointestinal bleeding in 129 (71.66%), chronic unexplained abdominal pain in 20 (11.11%), suspected small-bowel abnormality in the form of narrowing and/or mass on imaging in 10 (5.5%), chronic diarrhea in 9 (5%), unexplained iron deficiency anemia in 9 (5%), and retained capsule in 2 (1.11%). The most common finding was ulcer, which was noted in 45 (25%) patients followed by stricture in 8 (4.44%) and both ulcers and strictures in 6 (3.33%) patients. SBE was normal in 61 (33.88%) patients. SBE gave a diagnosis in 66.11% while in 28.43% cases, therapeutic intervention was done. Minor complications like bleeding were noted in 3 patients and mild acute pancreatitis in 2 patients. Jejunal perforation requiring surgical intervention was noted in 1 patient. CONCLUSION: SBE is a safe and effective procedure in diagnosing and treating small-bowel diseases.
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Enfermedades Intestinales/diagnóstico , Enfermedades Intestinales/cirugía , Intestino Delgado/patología , Intestino Delgado/cirugía , Enteroscopia de Balón Individual/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Enfermedades Intestinales/patología , Masculino , Persona de Mediana Edad , Seguridad , Enteroscopia de Balón Individual/efectos adversos , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: The efficacy and safety of peroral direct cholangioscopy (PDCS) in patients with surgically altered anatomy (SAA) are unclear. The present study aimed to evaluate the efficacy and safety of short-type single balloon enteroscope (s-SBE)-assisted PDCS using an ultra-slim endoscope in patients with SAA. MATERIALS AND METHODS: We retrospectively analyzed 12 sessions of PDCS performed in 8 patients with surgically altered gastrointestinal or pancreatobiliary anatomy between November 2017 and September 2019 at our institution. Endoscopic retrograde cholangiopancreatography using s-SBE was initially performed. Subsequently, the s-SBE was exchanged for an ultra-slim endoscope through an overtube with an inflated balloon to perform PDCS. We analyzed the success rates and adverse events resulting from the procedure. RESULTS: Six patients had biliary stones and 2 had biliary strictures. The types of reconstruction were Roux-en-Y choledochojejunostomy (n=5), Billroth II gastrectomy (n=2), and Roux-en-Y gastrectomy (n=1). Biliary insertion of the ultra-slim endoscope was successful in all 12 sessions. Biliary interventions included electronic hydraulic lithotripsy in 5 sessions, stone removal using basket catheter in 3 sessions, biopsy in 2 sessions, and diagnosis of no residual stones in 2 sessions. Complete stone removal was finally achieved in all 6 patients with biliary stones. Biliary strictures in 2 patients were diagnosed as adenocarcinoma following a biopsy. The adverse events were cholangitis of mild severity in 3 sessions. CONCLUSION: S-SBE-assisted PDCS using an ultra-slim endoscope was useful and safe in patients with SAA, although care should be taken to avoid adverse events.
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Enfermedades de las Vías Biliares/patología , Enfermedades de las Vías Biliares/cirugía , Colangiopancreatografia Retrógrada Endoscópica/instrumentación , Endoscopios , Complicaciones Posoperatorias/epidemiología , Enteroscopia de Balón Individual/instrumentación , Anciano , Anciano de 80 o más Años , Anastomosis en-Y de Roux , Enfermedades de las Vías Biliares/etiología , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Coledocostomía , Femenino , Gastrectomía , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Enteroscopia de Balón Individual/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND This study aimed to identify the risk factors of complications after small-intestinal polypectomy by single-balloon enteroscopy (SBE), and to assess the value of serum C-reactive protein (CRP) and the max polyp diameter (Dmax) in predicting postoperative complications of small-intestinal polypectomy. MATERIAL AND METHODS Between April 2017 and April 2018, clinical data from 37 patients who underwent small-intestinal polypectomy were retrospectively analyzed. RESULTS Thirty-seven small-intestinal polypectomy procedures (18 oral and 19 anal) were carried out in 37 patients (M: F 20: 17; age 35.6±13.0 years). A total of 1081 small-intestine polyps were removed. Three patients (8.1%) had bleeding and 3 patients (8.1%) had perforation after small-intestinal polypectomy. Based on multivariate logistic analysis, CRP [1.104 (95% CI 1.022-1.191)] was the only risk factor for complications among the patients. According to the area under the receiver operating characteristic (AUROC) curve, CRP (27.5 mg/L), Dmax (3.5 cm), and the combination of CRP + Dmax appear to be predictive factors for complications after small-intestinal polypectomy. CONCLUSIONS SBE is an effective endoscopic tool for patients with small-intestinal polyps. CRP, Dmax, and the combination of CRP+Dmax may be potential predictors of complications from small-intestinal polypectomy.
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Pólipos Intestinales/cirugía , Enteroscopia de Balón Individual/métodos , Adulto , Área Bajo la Curva , Biomarcadores/sangre , Biopsia , Proteína C-Reactiva/análisis , China , Pólipos del Colon/cirugía , Colonoscopía/métodos , Femenino , Hemorragia/complicaciones , Humanos , Pólipos Intestinales/complicaciones , Intestino Delgado/cirugía , Masculino , Persona de Mediana Edad , Análisis Multivariante , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de Riesgo , Enteroscopia de Balón Individual/efectos adversos , Enteroscopia de Balón Individual/mortalidadRESUMEN
BACKGROUND: Bilioenteric Roux-en-Y anastomosis is one of the most complicated approaches for reconstructing the gastrointestinal tract, and endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients after bilioenteric Roux-en-Y anastomosis. The optimal endoscopic strategies for such cases remain unknown. AIM: To explore the feasibility and effectiveness of single balloon enteroscopy-assisted (SBE-assisted) therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis based on multi-disciplinary collaboration between endoscopists and surgeons as well as report the experience from China. METHODS: This is a single center retrospective study. All of the SBE-assisted therapeutic ERCP procedures were performed by the collaboration between endoscopists and surgeons. The operation time, success rate, and complication rate were calculated. RESULTS: Forty-six patients received a total of 64 SBE-assisted therapeutic ERCP procedures, with successful scope intubation in 60 (93.8%) cases and successful diagnosis in 59 (92.2%). All successfully diagnosed cases received successful therapy. None of the cases had perforation or bleeding during or after operation, and no post-ERCP pancreatitis occurred. CONCLUSION: Based on multi-disciplinary collaboration, SBE-assisted therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis is relatively safe and effective and has a high success rate.
Asunto(s)
Anastomosis en-Y de Roux/efectos adversos , Enfermedades de las Vías Biliares/cirugía , Colangiopancreatografia Retrógrada Endoscópica/métodos , Enfermedades Pancreáticas/cirugía , Reoperación/métodos , Enteroscopia de Balón Individual/métodos , Anciano , Anciano de 80 o más Años , China/epidemiología , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Grupo de Atención al Paciente , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Reoperación/efectos adversos , Estudios Retrospectivos , Enteroscopia de Balón Individual/efectos adversosRESUMEN
Objetive: To describe our experience with single balloon enteroscopy in the management of small bowel disease in British American Hospital, Lima - Perú. MATERIAL AND METHODS: Descriptive and prospective study. We include all patients that come to perform a single balloon enteroscopy in small bowel unit of British American Hospital within December 2012 to December 2018. RESULTS: We performed 80 procedures of single balloon enteroscopy, 49 were done by oral approach, 31 by rectal approach. Mean age were 60.78 years-old (20 - 88 years). 48 patients (60%) were male. The mean insertion time for oral approach was 80 minutes (55-141 minutes), and for rectal approach was 110 minutes (55-180 minutes). The main indication for single balloon enteroscopy was obscure gastrointestinal bleeding. 6 enteroscopies were performed in patients with altered surgical anatomy (7.5%). 70 of 80 procedures (87.5%) were performed with gastroenterology-administered sedation, using midazolam, pethidine and propofol, without any respiratory or hemodinamic complication. Diagnostics achieved by single balloon enteroscopy were small bowel angiodysplasias (20%), yeyuno ileal ulcers (17.5%) and small bowel neoplasia (7.5%). Paralytic ileus was the most common complication of single balloon enteroscopy, 2 cases, and both cases were associated after no using carbon dioxide insufflation during procedure. CONCLUSION: Obscure gastrointestinal bleeding was the main indication for single balloon enteroscopy. Diagnostics achieved by single balloon enteroscopy were small bowel angiodysplasias (20%), yeyuno ileal ulcers (17.5%) and small bowel neoplasia (7.5%). Paralytic ileus was the most common complication of single balloon enteroscopy, 2 cases, and both cases were associated after no using carbon dioxide insufflation during procedure.
Asunto(s)
Enfermedades Intestinales/diagnóstico , Intestino Delgado/patología , Enteroscopia de Balón Individual , Adulto , Anciano , Anciano de 80 o más Años , Angiodisplasia/complicaciones , Angiodisplasia/diagnóstico , Femenino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Unidades Hospitalarias/estadística & datos numéricos , Humanos , Cooperación Internacional , Enfermedades Intestinales/terapia , Neoplasias Intestinales/complicaciones , Neoplasias Intestinales/diagnóstico , Seudoobstrucción Intestinal/etiología , Masculino , Persona de Mediana Edad , Perú , Estudios Prospectivos , Estudios Retrospectivos , Enteroscopia de Balón Individual/efectos adversos , Adulto JovenRESUMEN
BACKGROUND: Device assisted enteroscopy (DAE) is increasingly being carried out in elderly patients. This provides a challenge due to the underlying varied physiology and comorbidities these patients have. METHODS: We performed a systematic literature search for studies on elderly patients undergoing DAE. We calculated the pooled diagnostic (DY) and therapeutic yields (TY), major adverse events, length of small bowel examined and sedation administered. These were also compared to younger patients. RESULTS: Fourteen high quality articles on DAE in the elderly were included in this analysis (3289 total, 1712 elderly) patients. Nine of these studies were included in the final meta-analysis (681 elderly, 1577 young patients). The overall DY of DAE, double balloon enterosocpy (DBE) and single balloon enteroscopy (SBE) were 0.68 (p = 0.000001), 1.74 (p = 0.0001) and 1.90 (p = 0.009). The TY of DAE, DBE and SBE were 0.45 (p = 0.00001), 2.20 (p = 0.00001) and 2.36 (p = 0.00001). On comparison of elderly and young patients, DY (1.83; 95% CI: 1.49, 2.24; p = 0.00001) and TY (2.28; 95% CI: 1.79, 2.89) were better in elderly patients. There was no difference in adverse events in both groups (2.16; 95% CI: 0.82, 5.69, p = 0.12). Elderly patients were given less sedation than younger patients during DAE. CONCLUSIONS: DAE has a higher DY and TY in the elderly than younger patients. DAE can be safely carried out in the elderly with less sedation.
Asunto(s)
Sedación Consciente , Enteroscopía de Doble Balón/métodos , Enfermedades Intestinales/diagnóstico por imagen , Enteroscopia de Balón Individual/métodos , Anciano , Enteroscopía de Doble Balón/efectos adversos , Humanos , Intestino Delgado/diagnóstico por imagen , Enteroscopia de Balón Individual/efectos adversosRESUMEN
Objetivo: Describir la experiencia en el uso de la enteroscopia asistida por balón simple para el diagnóstico y manejo de la patología del intestino delgado en pacientes con anatomía normal y alterada por cirugía en la Clínica Anglo Americana. Material y método: El presente es un estudio descriptivo - retrospectivo que incluye a todos los pacientes que acudieron a la Unidad de Intestino Delgado de la Clínica Anglo Americana, para realizarse una enteroscopia asistida por balón durante el periodo comprendido entre diciembre del 2012 a diciembre del 2018. Resultados: Se realizaron 80 procedimientos de enteroscopia asistida por balón simple, 49 fueron realizados por via anterógrada y 31 por vía retrógrada. La edad promedio fue 60,78 años (20 a 88 años). 48 pacientes (60%) eran varones. El tiempo de inserción media fue 80 minutos para la vía anterógrada (55 - 141 minutos) y 110 minutos para la vía retrógrada (55 -180 minutos). La principal indicación para realizar la enteroscopia por balón simple fue hemorragia digestiva oscura, 45 casos (56,25%). Se realizaron 6 estudios de enteroscopias asistida por balón en pacientes con anatomía alterada (7,5%). Setenta de los ochenta procedimientos (87,5%) fueron realizados con sedación administrada por enfermería supervisada por gastroenterólogo en base a midazolam, petidina y propofol, no se presentó ninguna complicación respiratoria o hemodinámica. Los diagnósticos obtenidos más frecuentes por enteroscopia fueron: angiodisplasias de intestino delgado (20%), úlceras yeyuno ileales (17,5%) y neoplasias a nivel del intestino delgado (7,5%). La complicación que se presentó con más frecuencia posterior a la enteroscopia fue el íleo paralítico, 2 casos, y se asoció a no utilizar insuflación con dióxido de carbono durante el procedimiento. Conclusiones: La hemorragia digestiva oscura fue la principal indicación para realizar una enteroscopia asistida por balón simple. Los diagnósticos más frecuentes fueron angiodisplasias, úlceras yeyuno ileales y neoplasias a nivel del intestino delgado. La complicación más frecuente fue el íleo paralítico y se asoció a no utilizar insuflación con dióxido de carbono durante el procedimiento.
Objetive: To describe our experience with single balloon enteroscopy in the management of small bowel disease in British American Hospital, Lima - Perú. Material and methods: Descriptive and prospective study. We include all patients that come to perform a single balloon enteroscopy in small bowel unit of British American Hospital within December 2012 to December 2018. Results: We performed 80 procedures of single balloon enteroscopy, 49 were done by oral approach, 31 by rectal approach. Mean age were 60.78 years-old (20 - 88 years). 48 patients (60%) were male. The mean insertion time for oral approach was 80 minutes (55-141 minutes), and for rectal approach was 110 minutes (55-180 minutes). The main indication for single balloon enteroscopy was obscure gastrointestinal bleeding. 6 enteroscopies were performed in patients with altered surgical anatomy (7.5%). 70 of 80 procedures (87.5%) were performed with gastroenterology-administered sedation, using midazolam, pethidine and propofol, without any respiratory or hemodinamic complication. Diagnostics achieved by single balloon enteroscopy were small bowel angiodysplasias (20%), yeyuno ileal ulcers (17.5%) and small bowel neoplasia (7.5%). Paralytic ileus was the most common complication of single balloon enteroscopy, 2 cases, and both cases were associated after no using carbon dioxide insufflation during procedure. Conclusion: Obscure gastrointestinal bleeding was the main indication for single balloon enteroscopy. Diagnostics achieved by single balloon enteroscopy were small bowel angiodysplasias (20%), yeyuno ileal ulcers (17.5%) and small bowel neoplasia (7.5%). Paralytic ileus was the most common complication of single balloon enteroscopy, 2 cases, and both cases were associated after no using carbon dioxide insufflation during procedure
Asunto(s)
Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Enteroscopia de Balón Individual , Enfermedades Intestinales/diagnóstico , Intestino Delgado/patología , Perú , Seudoobstrucción Intestinal/etiología , Estudios Prospectivos , Estudios Retrospectivos , Angiodisplasia/complicaciones , Angiodisplasia/diagnóstico , Enteroscopia de Balón Individual/efectos adversos , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Unidades Hospitalarias/estadística & datos numéricos , Cooperación Internacional , Enfermedades Intestinales/terapia , Neoplasias Intestinales/complicaciones , Neoplasias Intestinales/diagnósticoRESUMEN
OBJECTIVES: The benefit of balloon-assisted enteroscopy (BAE) had been recently documented in pediatric patients, but previous reports are based on single institution experiences. We evaluated the feasibility of pediatric BAE in 8 tertiary referral hospitals throughout Japan. METHODS: This was a prospective, multi-institutional study. Patients younger than 18 years were enrolled between April 2014 and March 2017 to undergo double-balloon or single-balloon enteroscopy. Data were collected prospectively using a standardized questionnaire. RESULTS: We enrolled 79 pediatric patients (96 procedures, 70 boys, 26 girls; median age 12.7 years, range 1-17 years). Antegrade (oral-route) BAE was performed in 20 procedures (lowest body weight 12.9âkg, youngest age 3.7 years), and retrograde (anal-route) BAE in 76 (lowest body weight 10.8âkg, youngest age 1.6 years). Severe adverse events were associated with BAE in 2 patients: 1 with hemorrhage due to polypectomy and 1 with pancreatitis after double-balloon endoscopic retrograde cholangioscopy. No intestinal perforation was reported. Procedure duration of oral-route BAE for diagnosis was significantly longer than anal-route for diagnosis (Pâ<â0.001). The overall diagnostic yield for rectal bleeding/positive fecal occult blood test and abdominal pain was 48%. Among 40 patients referred for diagnosis who did not undergo capsule endoscopy, diagnoses were confirmed in 17 (42.5%) patients after BAE. CONCLUSIONS: This prospective multicenter observational study documents the efficacy of BAE in pediatric patients.
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Enteroscopía de Doble Balón/métodos , Enteroscopia de Balón Individual/métodos , Adolescente , Niño , Preescolar , Enteroscopía de Doble Balón/efectos adversos , Femenino , Humanos , Lactante , Enfermedades Intestinales/diagnóstico , Intestino Delgado/cirugía , Japón , Masculino , Tempo Operativo , Estudios Prospectivos , Enteroscopia de Balón Individual/efectos adversosRESUMEN
SMALL-BOWEL CAPSULE ENDOSCOPY (SBCE): 1: ESGE recommends that prior to SBCE patients ingest a purgative (2âL of polyethylene glycol [PEG]) for better visualization.Strong recommendation, high quality evidence.However, the optimal timing for taking purgatives is yet to be established. 2: ESGE recommends that SBCE should be performed as an outpatient procedure if possible, since completion rates are higher in outpatients than in inpatients.Strong recommendation, moderate quality evidence. 3: ESGE recommends that patients with pacemakers can safely undergo SBCE without special precautions.Strong recommendation, low quality evidence. 4: ESGE suggests that SBCE can also be safely performed in patients with implantable cardioverter defibrillators and left ventricular assist devices.Weak recommendation, low quality evidence. 5: ESGE recommends the acceptance of qualified nurses and trained technicians as prereaders of capsule endoscopy studies as their competency in identifying pathology is similar to that of medically qualified readers. The responsibility of establishing a diagnosis must however remain with the attending physician.Strong recommendation, moderate quality evidence. 6: ESGE recommends observation in cases of asymptomatic capsule retention.Strong recommendation, moderate quality evidence.In cases where capsule retrieval is indicated, ESGE recommends the use of device-assisted enteroscopy as the method of choice.Strong recommendation, moderate quality evidence. DEVICE-ASSISTED ENTEROSCOPY (DAE): 1: ESGE recommends performing diagnostic DAE as a day-case procedure in patients without significant underlying co-morbidities; in patients with co-morbidities and/or those undergoing a therapeutic procedure, an inpatient stay is recommended.Strong recommendation, low quality evidenceThe choice between different settings also depends on sedation protocols.Strong recommendation, low quality evidence. 2: ESGE suggests that conscious sedation, deep sedation, and general anesthesia are all acceptable alternatives: the choice between them should be governed by procedure complexity, clinical factors, and local organizational protocols.Weak recommendation, low quality evidence. 3: ESGE recommends that the findings of previous diagnostic investigations should guide the choice of insertion route.Strong recommendation, moderate quality evidence.If the location of the small-bowel lesion is unknown or uncertain, ESGE recommends that the antegrade route should be generally preferred.Strong recommendation, low quality evidence.In the setting of massive overt bleeding, ESGE recommends an initial antegrade approach.Strong recommendation, low quality evidence. 4: ESGE recommends that, for balloon-assisted enteroscopy (i.âe., single-balloon enteroscopy [SBE] and double-balloon enteroscopy [DBE]), small-bowel insertion depth should be estimated by counting net advancement of the enteroscope during the insertion phase, with confirmation of this estimate during withdrawal.Strong recommendation, low quality evidence.ESGE recommends that, for spiral enteroscopy, insertion depth should be estimated during withdrawal.Strong recommendation, moderate quality evidence. Since the calculated insertion depth is only a rough estimate, ESGE recommends placing a tattoo to mark the identified lesion and/or the deepest point of insertion.Strong recommendation, low quality evidence. 5: ESGE recommends that all endoscopic therapeutic procedures can be undertaken at the time of DAE.Strong recommendation, moderate quality evidence.Moreover, when therapeutic interventions are performed, additional specific safety measures are needed to prevent complications.Strong recommendation, high quality evidence.
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Catárticos/administración & dosificación , Sedación Consciente , Sedación Profunda , Endoscopía Gastrointestinal/métodos , Endoscopía Gastrointestinal/normas , Enfermedades Intestinales/diagnóstico por imagen , Anestesia General , Antiespumantes/administración & dosificación , Endoscopía Capsular/efectos adversos , Endoscopía Capsular/métodos , Endoscopía Capsular/normas , Dióxido de Carbono , Enteroscopía de Doble Balón/efectos adversos , Enteroscopía de Doble Balón/métodos , Enteroscopía de Doble Balón/normas , Ingestión de Líquidos , Ingestión de Alimentos , Endoscopía Gastrointestinal/efectos adversos , Fluoroscopía , Humanos , Insuflación/métodos , Insuflación/normas , Intestino Delgado/diagnóstico por imagen , Enteroscopia de Balón Individual/efectos adversos , Enteroscopia de Balón Individual/métodos , Enteroscopia de Balón Individual/normasRESUMEN
INTRODUCTION: there is a lot of controversy with regard to who should be responsible for sedation during digestive endoscopy, particularly in advanced procedures that require deep sedation such as enteroscopy. The aim of this study was to evaluate the endoscopist-directed sedation viability during single balloon enteroscopy. MATERIAL AND METHOD: this was a prospective, observational study of a series of consecutive enteroscopies. The clinical staff included an endoscopist, scrub nurse and a nurse in charge of monitoring and sedative administration. The following parameters were monitored: pulse oximetry, blood pressure (every five minutes), electrocardiogram and respiratory rate. There was continuous supplemental oxygen and CO2 insufflation. The patient was in the left lateral decubitus position and a fluoroscopic control was used. RESULTS: forty-four explorations were performed in 39 patients, 24 were male and 15 female. The median age was 74 (18-89) and the ASA score was I in 12 cases, II in 23 cases and III in nine cases. Comorbidities were present in 68% of cases. The drugs used included propofol in 23 cases, propofol and midazolam in ten cases, propofol/midazolam/fentanyl in two cases, propofol and fentanyl in two cases, and midazolam/fentanyl in seven cases. All procedures were complete. The length of the procedure was 52 minutes (20-120). There were diagnostic findings in 65.9% of cases and therapeutic measures in 47.7%. There were no severe complications and the rate of complications derived from sedation was 22.7%. CONCLUSION: endoscopist-directed sedation is effective and safe for single balloon enteroscopy. Multi-center and wider studies are needed in order to better assess the efficacy, safety and efficiency of sedation controlled by a non-anesthetist during advanced endoscopy in this field.
Asunto(s)
Sedación Consciente/métodos , Enteroscopia de Balón Individual/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Sedación Consciente/efectos adversos , Femenino , Humanos , Hipnóticos y Sedantes/administración & dosificación , Hipnóticos y Sedantes/efectos adversos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico , Enfermeras y Enfermeros , Estudios Prospectivos , Enteroscopia de Balón Individual/efectos adversos , Adulto JovenRESUMEN
BACKGROUND: Roux-en-Y reconstructive surgery excludes the biliopancreatic system from conventional endoscopic access. Balloon-assisted enteroscopy allows therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in these patients, avoiding rescue surgery. The objective of the current study is to compare success and complication rate of double-balloon (DBE) and single-balloon enteroscope (SBE) to perform ERCP in Roux-en-Y patients. METHODS: Seventy three Roux-en-Y patients with suspected biliary tract pathology underwent balloon-assisted enteroscopy in a tertiary-care center. Retrospective analysis of 95 consecutive therapeutic ERCP procedures was performed to define and compare success and complication rate of DBE and SBE. RESULTS: Male-female ratio was 28/45 with a mean age of 58 ± 2 years. 30 (32 %) procedures were performed with DBE and 65 (68 %) with SBE. Overall ERCP success rate was 73 % for DBE and 75 % for SBE (P = 0.831). Failure was due to inability to reach or cannulate the intact papilla or bilioenteric anastomosis. Success rate was significantly higher when performed at the bilioenteric anastomosis (80 % success in 56 procedures) or at the intact papilla in short-limb Roux-en-Y (80 % in 15 procedures) as compared to the intact papilla in long-limb (58 % in 24 procedures; P = 0.040). Adverse event rates were 10 % (DBE) and 8 % (SBE) (P = 0.707) and mostly dealt with conservatively. CONCLUSIONS: ERCP after Roux-en-Y altered small bowel anatomy is feasible and safe using both DBE and SBE. Both techniques are equally competent with high success rates and acceptable adverse events rates. ERCP at the level of the intact papilla in long limb Roux-en-Y is less successful as compared to short-limb or bilioenteric anastomosis.
Asunto(s)
Anastomosis en-Y de Roux , Colangiopancreatografia Retrógrada Endoscópica/métodos , Enteroscopía de Doble Balón , Intestino Delgado/cirugía , Enteroscopia de Balón Individual , Adulto , Anciano , Anciano de 80 o más Años , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Enteroscopía de Doble Balón/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Enteroscopia de Balón Individual/efectos adversosRESUMEN
Endoscopic balloon dilation combined with stenting has been increasingly used in managing biliary anastomotic strictures (BAS) after orthotopic liver transplantation (OLT). However, data on the efficacy and safety vary among different studies. To obtain reliable estimates for the efficacy and safety of this endoscopic combination therapy in post-OLT BAS. A systematic search was conducted in the literature published until June 2012. The outcomes of individual study were transformed into comparable data using the Freeman-Tukey double arcsine transformation method. Fixed-effect or random-effect models were built to simulate the outcomes. Subgroup analysis and meta-regression were used to explore the sources of clinical heterogeneity. Clinical resolution and recurrence were defined as the primary outcomes and complications and mortality as secondary outcomes. Nineteen studies (15 retrospective, 4 prospective; 17 full-texts, 2 abstracts) were included, with a total of 745 patients. Fully covered self-expandable metal stent was only reported in one study, achieving a resolution rate of 92.3 %, recurrence rate of 8.3 %, and complication rate of 7.7 %. For 18 studies using plastic stents, the pooled resolution rate was 86 % (95 % CI 80-91 %; I (2) = 74.7 %). Abstracts, study design, and the delay from OLT to BAS diagnosis were contributing factors for heterogeneity in resolution. The pooled recurrence rate was 9 % (95 % CI 5-13 %; I (2) = 59.6 %). Longer stenting duration predicted less recurrence (OR = 0.95, p = 0.002). The pooled complication rate was 14 % (95 % CI 8-21 %, I (2) = 71.2 %). No procedure-related mortality was reported. Endoscopic balloon dilation combined with stenting is a relatively effective and safe modality in post-OLT BAS.