A Less Invasive Therapy By Diagnostic Double Baloon Intestinal Endoscopy (dbe) and Laparoscopic Salvage Surgery (lss)

Shigehiko Yagi, Fumiki Kushihata, Riki Ohno, Hideshi Yamamoto, Hirotsugu Yoshiyama, Hidenori Takatsuki, Yasutsugu Takada. DEPARTMENT OF SURGERY, Ehime Prefectural Imabari Hospital

Background: Double-balloon endoscopy (DBE) is a new method that allows visualization, tissue sampling, and therapeutic intervention of a variety of pathologies throughout the small-intestinal tract.?Objectives: we evaluated an efficacy of the new combinational strategy of DBE and less invasive laparoscopic surgery (LSS) and its impact on treatment and clinical outcome of patients with small intestinal deseases.  Methods: We present here five typical cases of this new strategy.  Results: Case 1; Due to disadvantage of invasive open laparotomy for intra-abdominal huge mass 9cm in diameter, diagnostic DBE revealed a full circumferential ulceration of jejunum and B cell lymphoma was confirmed. Following chemotherapy with R-CHOP regimen of four sessions successfully resulted in a remarkable tumor reduction with a stricture of jejunum. Following less invasive laparoscopic-assisted jejunostomy disclosed no residual variable lymphoma cells and resulted in no additional chemotherapy. Case 2, 3; Due to overt-on going GI bleeding and ileus, DBE showed a irregular ulceration of proximal jejunum and confirmed well differentiated adnenocarcinoma. Laparoscopic-assisted jejunostomy was done with radical lymphnodes resection along with superior mesenteric artery preserving first branch of jejunal artery. Pathological depth of invasion was subserosa with no lymphnode metastasis. Pts were doing well and underwent following adjuvant chemotherapy using TS-1. Case 4, 5 DBE are also quite useful tool for diagnosis following benign cases such as IBD and Meckel’s diverticulm. ?We exfoliated the adhesion of the Meckel’s diverticulum tip by laparoscopically. Crohn disease with stricture and longitudinal ulceration of the small intestine was diagnosed by DBE, small intestine partial resection and intestinal strictureplasty using laparoscopy was done due to failure of TNF α antibody therapy. This new strategy leads us to more accurate and less invasive strategy to intestinal deseases.  Conclusion: A shift in the diagnostic and therapeutic algorithm was noticed in the combination strategy with DBE and SLS now taking the lead.

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