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Double-balloon endoscopy better for visualizing small intestine

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Complete visualization of the entire small intestine is achieved more easily with double-balloon endoscopy than with single-balloon endoscopy, according to a report from Japan appearing in Gastrointestinal Endoscopy online January 27.

The authors explain that double-balloon endoscopy (DBE) allows access to the small intestine. Inflating and deflating the balloons — one at the end of the endoscope and one attached to a soft overtube — facilitates deep insertion by preventing loop formations. Single-balloon endoscopy (SBE) was recently introduced.

To compare the performance of the two techniques, Dr. Hirotsugu Watabe and colleagues at the University of Tokyo conducted a randomized trial in 38 patients. SBE was used in 18 patients and DBE in 20. “The primary outcome measurement of the current study was the success rate for total small-bowel observation,” the authors note.

The total enteroscopy rate was 0% in the SBE group and 57% in the DBE group (p=0.002), despite a longer examination time in the SBE group (185.9 minutes) than in the DBE group (160.7 minutes), according to the report. The study was terminated when the obvious disadvantage of SBE became apparent on interim analysis.

Secondary outcomes demonstrated no difference between the two techniques in terms of complications, findings, and clinical outcomes.

Dr. Watabe and colleagues acknowledge that at the start of the study, the team had performed only 10 SBEs versus 248 DBEs. “As we develop more experience with performing SBE, the total enteroscopy rate by using SBE may increase.”

Nonetheless, they say that total enteroscopy is easier with DBE than SBE, and conclude: “We should use DBE in patients requiring total enteroscopy.”

Reference:

Single-balloon versus double-balloon endoscopy for achieving total enteroscopy: a randomized, controlled trial

Gastrointest Endosc 2011.