Çift balonlu enteroskopi: Tek merkez deneyimi

Öz

Giriş ve Amaç: Çift balonlu enteroskopi ince bağırsak anormalliklerinin tanısının konulması ve girişimsel işlemlerinin yapılmasında önemli bir prosedürdür. Bu çalışmada Doğu Karadeniz Bölgesi’ndeki çift balonlu enteroskopi işlemi uygulanan hastaların değerlendirilmesi planlandı. Gereç ve Yöntem: Bu çalışmada Ağustos 2017 - Ocak 2023 tarihleri arasında; hastaların çift balonlu enteroskopi yapılma endikasyonları, demografik özellikleri, laboratuvar tetkikleri, görüntüleme yöntemleri, endoskopik bulguları, histopatolojik sonuçları, endoskopik girişimsel işlemler ve komplikasyonları retrospektif olarak değerlendirildi. Bulgular: Hastaların 30’u (%56) erkek, 24’ü (%44) kadın olup, ortanca enteroskopi yapılma yaşı 52 (17 - 84) /yıldı. En sık çift balonlu enteroskopi yapılma endikasyonları gizli gastrointestinal kanama (%28) ve aşikar gastrointestinal kanama (%22) idi. Enteroskopide en sık izlenen lezyon ülser, inflamasyon veya mukozal lezyon (%17) ve en sık konulan tanı Crohn hastalığı (%15) idi. Görüntüleme tetkikleri normal olan 10 hastanın 4’ünün (%40) endoskopi bulguları anormal idi ve bu hastalar adenokarsinom (%10), polip (%10), anjiodisplazi (%10) ve Crohn hastalığı (%10) tanıları aldı. Endoskopi bulguları normal olan, fakat görüntüleme yöntemlerinde anormallik izlenen 1 (%4) hastaya lenfoma tanısı konuldu. Çift balonlu enteroskopi yapılma endikasyonu gastrointestinal kanama olan hastalarda, sıklıkla tümöral (%11) ve vasküler lezyonlar (%11) izlendi ve bu hastaların çoğuna kanser ve anjiodisplazi tanısı konuldu. Gastrointestinal kanama dışındaki nedenler ile çift balonlu enteroskopi yapılan hastalarda ise, en sık ülser, inflamasyon veya mukozal lezyon (%33) tespit edildi ve bu hastaların çoğuna Crohn hastalığı (%26) tanısı konuldu. Sonuç: Çift balonlu enteroskopi ince bağırsak hastalıklarının tanısının konulmasında ve terapötik işlemlerin yapılmasında etkili ve güvenli bir prosedürdür. Bununla birlikte, ince bağırsak hastalığı için çift balonlu enteroskopi yanında klinik ve radyolojik bulgularda dikkate alınmalıdır.

Anahtar Kelimeler

• Çift balonlu enteroskopi
• klinik
• radyolojik bulgular

Double-balloon enteroscopy: The single center experience

Öz

Background and Aims: Double-balloon enteroscopy is an important procedure for diagnosing small bowel abnormalities and performing interventional procedures. It was planned to evaluate the patients who underwent double-balloon enteroscopy in the Eastern Black Sea Region in this study. Materials and Methods: Patients who underwent double-balloon enteroscopy in our clinic between August 2017 and January 2023 were included in this study. Indications for double-balloon enteroscopy, demographic characteristics, laboratory tests, imaging methods, endoscopic findings, histopathological results, endoscopic interventional procedures and complications were evaluated retrospectively. Results: Thirty (56%) of the patients were male and 24 (44%) were female, and the median age at which enteroscopy was performed was 52 (17 - 84) /year. The most common indications for double-balloon enteroscopy were occult gastrointestinal bleeding (28%) and overt gastrointestinal bleeding (22%). The most common lesion observed in enteroscopy was ulcer, inflammation or mucosal lesion (17%) and most common diagnosis was Crohn’s disease (15%). Endoscopic findings of 4 (40%) of 10 patients with normal imaging examinations were abnormal, and these patients were diagnosed with adenocarcinoma (10%), polyp (10%), angiodysplasia (10%) and Crohn's disease (10%). Lymphoma was diagnosed in 1 (4%) patient with normal endoscopy findings but abnormal imaging methods. Tumor (11%) and vascular lesions (11%) were frequently observed in patients with gastrointestinal bleeding indication for double-balloon enteroscopy, and these patients were frequently diagnosed with cancer and angiodysplasia. In patients who underwent double-balloon enteroscopy for reasons other than gastrointestinal bleeding, the most common lesions were ulcer, inflammation or mucosal lesion (33%), and most of these patients (26%) were diagnosed with Crohn's disease. Conclusion: Double-balloon enteroscopy is an effective and safe procedure for diagnosing small bowel diseases and performing therapeutic procedures. However, clinical and radiological findings should be considered in addition to double-balloon enteroscopy for small bowel diseases.

Anahtar Kelimeler

• Double-balloon enteroscopy
• clinical
• radiological findings

Kaynakça

1. 1. Zuckerman GR, Prakash C, Askin MP, Lewis BS. AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology 2000;118:201-21.
2. 2. Hsu CM, Chiu CT, Su MY, et al. The outcome assessment of double-balloon enteroscopy for diagnosing and managing patients with obscure gastrointestinal bleeding. Dig Dis Sci 2007;52:162-6.
3. 3. Liu MK, Yu FJ, Wu JY, et alApplication of capsule endoscopy in small intestine diseases: analysis of 28 cases in Kaohsiung Medical University Hospital. Kaohsiung J Med Sci 2006;22:425-31.
4. 4. Singeap AM, Stanciu C, Trifan A. Capsule endoscopy: The road ahead. World J Gastroenterol 2016;22:369-78.
5. 5. Yamamoto H, Sekine Y, Sato Y, et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 2001;53:216-20.
6. 6. Dişibeyaz S, Suna N, Kuzu UB, et al. Double balloon enteroscopy: A 7-year experience at a tertiary care Centre. Eurn J Inter Med 2016:33:108-11.
7. 7. Aabakken L, Bretthauer M, Line PD. Double-balloon enteroscopy for endoscopic retrograde cholangiography in patients with a Roux-en-Y anastomosis. Endoscopy 2007;39:1068-71.
8. 8. Emmett DS, Mallat DB. Double-balloon ERCP in patients who have undergone Roux-en-Y surgery: a case series. Gastrointes Endosc 2007;66:1038-41.

9. 9. Kim DH, Byeon JS, Lee SK, et al. Usefulness of double balloon endoscopy in patients with surgically distorted intesti-nal anatomy. J Clin Gastroenterol 2009;43:737-42.
10. 10. Hegde SR, Iffrig K, Li T, et al. Double-balloon enteroscopy in the elderly: safety, findings, and diagnostic and therapeutic success. GastrointestEndosc 2010;71:983-9.
11. 11. Lu L, Yang C, He T, et al. Single-centre empirical analysis of double-balloon enteroscopy in the diagnosis and treatment of small bowel diseases: A retrospective study of 466 cases. Surg Endosc 2022;36:7503-10.
12. 12. Roushan N, Froutan H, Taslimi R, et al. Double-balloon enteroscopy: The results of a new experience in Iran. Med J Islam Repub Iran 2014;28:19.
13. 13. Akarsu M, Özdinç SA, Celtik A, Akpınar H. Diagnostic and therapeutic efficacy of double-balloon endoscopy in patients with small intestinal diseases: single-center experience in 513 procedures. Turk J Gastroenterol 2014;25:374-80.
14. 14. Chen WG, Shan GD, Zhang H, et al. Double-balloon enteroscopy in small bowel diseases: Eight years single-center experience in China. Medicine (Baltimore) 2016;95:e5104.
15. 15. Nakayama S, Tominaga K, Obayashi T, et al. The prevalence of adverse events associated with double-balloon enteroscopy from a single-centre dataset in Japan. Dig Liver Dis 2014;46:706-9.
16. 16. Xin L, Liao Z, Jiang Y, Li ZS. Indications, detectability, positive findings, total enteroscopy, and complications of diagnostic double-balloon endoscopy: a systematic review of data over the first decade of use. Gastrointest Endosc 2011;74:563-70.
17. 17. Sheba E, Farag A, Aref W, et al. Double-balloon enteroscopy (DBE) in patients presenting with obscure gastrointestinal bleeding (OGIB). Arab J Gastroenterol 2017;18:228-33.