Clinical Gastroenterology and Hepatology
Volume 7, Issue 11 , Pages 1177-1182.e3, November 2009

Complications Associated With Double Balloon Enteroscopy at Nine US Centers

  • Lauren B. Gerson

      Affiliations

    • Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California
    • Corresponding Author InformationReprint requests Address requests for reprints to: Lauren B. Gerson, MD, MSc, Division of Gastroenterology and Hepatology, A149, 300 Pasteur Drive, Stanford, California 94305-5202. fax: (650) 723-8305
    • ,
  • Jeffrey Tokar

      Affiliations

    • Fox Chase Cancer Center, Philadelphia, Pennsylvania
    • ,
  • Michael Chiorean

      Affiliations

    • Indiana University, Indianapolis, Indiana
    • ,
  • Simon Lo

      Affiliations

    • Cedars Sinai Medical Center, Los Angeles, California
    • ,
  • G. Anton Decker

      Affiliations

    • Mayo Clinic, Scottsdale, Arizona
    • ,
  • David Cave

      Affiliations

    • University of Massachusetts, Worcester, Massachusetts
    • ,
  • Doumit BouHaidar

      Affiliations

    • University of Virginia, Charlottesville, Virginia
    • ,
  • Daniel Mishkin

      Affiliations

    • Boston University Medical Center, Boston, Massachusetts
    • ,
  • Charles Dye

      Affiliations

    • University of Chicago, Chicago, Illinois
    • ,
  • Oleh Haluszka

      Affiliations

    • Fox Chase Cancer Center, Philadelphia, Pennsylvania
    • ,
  • Jonathan A. Leighton

      Affiliations

    • Mayo Clinic, Scottsdale, Arizona
    • ,
  • Alvin Zfass

      Affiliations

    • University of Virginia, Charlottesville, Virginia
    • ,
  • Carol Semrad

      Affiliations

    • University of Chicago, Chicago, Illinois

published online 14 July 2009.

Background & Aims

Double balloon enteroscopy (DBE) was introduced into the US in 2004. Potential complications include perforation, pancreatitis, and gastrointestinal bleeding. Prevalence and risk factors for complications have not been described in a US population.

Methods

We conducted a retrospective study of DBE complications in 9 US centers. We obtained detailed information for each complication including patient history, maneuvers performed during the DBE, and presence of altered surgical anatomy.

Results

We collected data from 2478 DBE examinations performed from 2004 to 2008. The dataset included 1691 (68%) anterograde DBE, 722 (29%) retrograde DBE (including 5 per-stomal DBEs), and 65 (3%) DBE-facilitated endoscopic retrograde cholangiopancreatography ERCP cases. There were a total of 22 (0.9%) major complications including perforation in 11 (0.4%), pancreatitis in 6 (0.2%), and bleeding in 4 (0.2%) patients. One of 6 cases of pancreatitis occurred post retrograde DBE. Perforations occurred in 3/1691 (0.2%) anterograde examinations and 8/719 (1.1%) retrograde DBEs (P = .004). Eight (73%) perforations occurred during diagnostic DBE examinations. Four of 8 retrograde DBE perforations occurred in patients with prior ileoanal or ileocolonic anastomoses. In the subset of 219 examinations performed in patients with surgically altered anatomy, perforations occurred in 7 (3%), including 1/159 (0.6%) anterograde DBE examinations, 6/60 (10%) retrograde DBEs, and 1 of 5 (20%) peristomal DBE examinations (P < .005 compared with patients without surgically altered anatomy).

Conclusions

DBE is associated with a higher complication rate compared with standard endoscopic procedures. The perforation rate was significantly elevated in patients with altered surgical anatomy undergoing diagnostic retrograde DBE examinations.

Abbreviations used in this paper: APC, argon plasma coagulation, CT, computerized tomography, DBE, double balloon enteroscopy, ERCP, endoscopic retrograde cholangiopancreatography, FAP, familial adenomatous polyposis

 

 To view this article's video abstract, go to the AGA's YouTube Channel.

 Conflict of interest The authors disclose the following: Lauren B. Gerson received speaker's honoraria from Given Imaging Inc and grant support, speaker's honoraria, and equipment from Fujinon Inc. Jeffrey Tokar received grant support and speaker's honoraria from Fujinon Inc. Michael Chiorean is a consultant for Discovery Endoease (Spirus); he received speaker's honoraria from Given Imaging Inc. Simon Lo received grant support and speaker's honoraria from Fujinon Inc. G. Anton Decker received research support from Fujinon Inc. Daniel Mishkin is a consultant for US Endoscopy; he received grant support from EZEM and speaker's honoraria from Given Imaging Inc and Salix. Charles Dye received grant support and speaker's honoraria from Fujinon Inc. Oleh Haluszka is a consultant for EZEM; he received grant support and speaker's honoraria from Fujinon Inc. Jonathan A. Leighton is a consultant for Given Imaging Inc; he received grant support from Fujinon Inc, Olympus, and Given Imaging Inc. Carol Semrad received grant support and speaker's honoraria from Fujinon Inc. The remaining authors disclose no conflicts.

PII: S1542-3565(09)00659-4

doi:10.1016/j.cgh.2009.07.005

Clinical Gastroenterology and Hepatology
Volume 7, Issue 11 , Pages 1177-1182.e3, November 2009