Severe Complications after Double Balloon Enteroscopy

Double balloon enteroscopy (DBE) is a relatively new endoscopic technique to diagnose and treat small bowel disease. While it is becoming widely used, there are relatively few data regarding potential complications.

Methods: We reviewed all DBE cases at an academic medical center from 2006-2007. 39 DBEs were identified and three patients had severe complications (7.7%) secondary to their DBE procedures. All DBEs were performed by a single gastroenterologist in their first year of performing DBE.

Results: The first patient had a DBE for evaluation of Crohn’s disease after years of partial small bowel obstructions and chronic abdominal pain. This procedure resulted in an emergent exploratory laparotomy for two small bowel perforations. The second patient had a DBE performed for chronic anemia and capsule endoscopy evidence of arteriovenous malformations in the small bowel. The original DBE was non-diagnostic and was not able to advance the scope presumably secondary to adhesions. This patient was taken to the operating room and a laparoscopic assisted DBE study was performed. However, the patient later underwent urgent exploratory laparotomy for small bowel perforation. The third patient underwent double-balloon dilation for pyloric channel stenosis and gastric outlet obstruction. During the procedure, gastroenterologist visualized possible intraperitoneal. Patient subsequently underwent an exploratory laparotomy, gastrectomy, and gastrojejunostomy with Roux-en-Y reconstruction.

Literature review reveals limited studies and case reports for DBE complications despite its widespread use since first being described in 2001. The largest case series to date reports a much lower severe complication rate (0.6%) than our case series (7.7%). The diagnostic and therapeutic yields also vary widely. Specifically, the complication rate of DBE in patients for whom difficulty was encountered due to adhesion or stricture has not been studied.

Double balloon enteroscopy may be a valuable diagnostic and therapeutic tool in the right patients and with the right hands. Further studies of DBE in the setting of difficult advancement and more clearly defined procedural training should be explored.

Session: Podium Presentation

Program Number: S062

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