PMO-208 Double balloon enteroscopy in a district general hospital: the experience so far. (28th May 2012) - Parker, C
Abstract : Introduction: Double Balloon Enteroscopy (DBE) is widely used in clinical practice worldwide and can be used to explore the small bowel in an antegrade or retrograde approach. A DBE service at South Tyneside District Hospital was commenced in January 2010 to complement the existing capsule endoscopy service. Methods: Patient records were examined retrospectively for all DBE's performed at South Tyneside District Hospital between January 2010 and January 2012. Information recorded included: indication for procedure, route of procedure, average depth of insertion, findings of procedure, therapy performed, sedation used and complications. Results: A total of 37 procedures (17 (46%) in first 12 months, 20 (54%) in 2 nd ) were performed: 17 anal, 1 via ileostomy, 19 oral. 81% were done under sedation using a combination of midazolam and pethidine (average doses 4.7 mg midazolam, 62 μg pethidine), 19% were performed under GA. Average depth of insertion for all procedures was 197 cm for oral DBE and 81 cm for anal DBE. Average depth for year 1: 204 cm oral, 69 cm anal. Average depth of insertion for year 2: 190 cm oral, 93 cm anal. Indications: Suspected mid GI bleeding 30%, definite or suspected Crohns 46%, neoplasia, 10.5%, abnormal imaging 10.5%, symptoms/signs only 3%. See Abstract PMO-208 table 1 . DBE Findings: Diagnostic yield: 30% for occult GI bleeding, 46% for suspected or definite Crohns with an overall change in management (or can explain symptoms) in 37%. See Abstract PMO-208 table 2 . Overall biopsies were taken in 43% (37.5% year 1, 47% year 2). Therapy was performed in 9% (1 Crohn's stricture dilatation, 2 Peutz Jegher polypectomies.). There have been no complications. Conclusion: Our DBE service appears safe. In the second 12 months there were deeper depths of insertion for the anal approach suggesting the "learning curve" is greatest for this approach. Increasing amounts of therapy and tattoos are being performed as experience is increasing. A recently published systematic review of DBE 1 found the main indication for referral for DBE to be GI bleeding (60.2%), interestingly our results show a different picture with the main referral indication being Crohn's disease (in 46%) and GI bleeding in only 30% of cases. The overall rate of positive findings is lower than in the literature at 37% and may be due to the different referral indications as well as the small number of procedures performed so far. Competing interests: None declared. Reference: 1. Xin, et al. Indications, positive findings, total enteroscopy, and complications of DBE. GIE 2011;74 :563–70.