Intestinal Research

Original Article

Endoscopy

Prototype single-balloon enteroscopy with passive bending and high force transmission improves depth of insertion in the small intestine: Yasuhiro Morita, Shigeki Bamba, Osamu Inatomi, Kenichiro Takahashi, Takayuki Imai, Masaki Murata, Masashi Ohno, Masaya Sasaki, Tomoyuki Tsujikawa, Akira Andoh; Intest Res 2020;18(2):229-237. Published online April 9, 2020; DOI: https://doi.org/10.5217/ir.2019.09150

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Background/Aims
We retrospectively analyzed Crohn’s disease (CD) patients with small intestinal strictures who underwent single-balloon enteroscopy (SBE) to ascertain whether prototype SBEs with a passive bending mechanism and high force transmission insertion tube had better insertability in the small intestine than a conventional SBE.
Methods
Among 253 CD patients who underwent SBE, we identified 94 CD patients who had undergone attempted endoscopic balloon dilatation (EBD) for small intestinal stenosis for inclusion in this study. We analyzed whether the type of scope used for their initial procedure affected the cumulative surgery-free rate. For the insertability analysis, patients who underwent SBE at least twice were divided into 3 groups according to the type of scope used: conventional SBE only, prototype SBE only, and both conventional and prototype SBEs. For each group, depth of insertion, procedure time, and number of EBDs were compared in the same patient at different time points.
Results
The success rate of EBD was 88.3%. The 5- and 10-year cumulative surgery-free rate was 75.7% and 72.8%, respectively. Cox regression analysis indicated that the factors contributing to surgery were long stricture (≥2 cm), EBD failure, and elevated Crohn’s Disease Activity Index, but not the type of scope used for EBD. The prototype SBEs significantly improved the depth of insertion (P=0.03, Wilcoxon’s signed-rank test).
Conclusions
In CD patients with small intestinal stenosis, the prototype SBEs with a passive bending mechanism and high force transmission insertion tube did not improve long-term EBD outcome but did improve deep insertability. (Clinical Trial Registration No. UMIN000037102)

Citations

Citations to this article as recorded by

Leucine-rich alpha-2 glycoprotein as a superior biomarker to C-reactive protein for detecting small bowel lesions in Crohn’s disease
Masashi Ohno, Atsushi Nishida, Akinori Otsuki, Yoshihiro Yokota, Takayuki Imai, Shigeki Bamba, Osamu Inatomi
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Role of Device-Assisted Enteroscopy in Crohn’s Disease
Giulia Catassi, Clelia Marmo, Antonio Gasbarrini, Maria Elena Riccioni
Journal of Clinical Medicine.2024; 13(13): 3919. CrossRef
Performance of Balloon-Assisted Enteroscopy for Non-ERCP Indications in Patients with Surgically Altered Gastrointestinal Anatomy
Ji Hee Song, Seong Ran Jeon, Jin Su Kim, Bo-In Lee, Jin-Oh Kim, Han Hee Lee
Digestive Diseases and Sciences.2023; 68(6): 2545. CrossRef
Rebleeding Rate and Risk Factors for Rebleeding after Device-Assisted Enteroscopy in Patients with Obscure Gastrointestinal Bleeding: A KASID Multicenter Study
Yuna Kim, Jae-Hyun Kim, Eun-Ae Kang, Soo-Jung Park, Jae-Jun Park, Jae-Hee Cheon, Tae-Il Kim, Jihye Park, Seong-Ran Jeon
Diagnostics.2022; 12(4): 954. CrossRef
Intestinal stricture in Crohn's disease: A 2020 update
Xiao Xuan Lin, Yun Qiu, Xiao Jun Zhuang, Fen Liu, Xiao Min Wu, Min Hu Chen, Ren Mao
Journal of Digestive Diseases.2021; 22(7): 390. CrossRef
Factors Affecting Route Selection of Balloon-Assisted Enteroscopy in Patients with Obscure Gastrointestinal Bleeding: A KASID Multicenter Study
Dong Hoon Baek, Seonyeong Hwang, Chang Soo Eun, Seong Ran Jeon, Jinsu Kim, Eun Ran Kim, Dong-Hoon Yang, Hyun Joo Jang, Jong Pil Im, Soo Jung Park, Sung Hoon Jung
Diagnostics.2021; 11(10): 1860. CrossRef

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Case Reports

Capsule retention caused by duodenal metastases from primary appendiceal adenocarcinoma: Jen-Wei Chou, Ken-Sheng Cheng; Intest Res 2017;15(1):130-132. Published online January 31, 2017; DOI: https://doi.org/10.5217/ir.2017.15.1.130

Abstract PDF PubReader ePub: Metastatic small bowel cancers are extremely rare in clinical practice. Primary appendiceal adenocarcinoma with gastrointestinal metastasis is seldom reported in the literature. Here, we describe the case of an 80-year-old male patient with primary appendiceal adenocarcinoma, who presented to China Medical University Hospital with mid-gastrointestinal tract bleeding. Capsule endoscopy revealed stenotic bowel lumen, but the capsule was retained in the distal duodenum. Double-balloon enteroscopy demonstrated erosive and erythematous mucosa in the region of capsule retention. The retained capsule was retrieved successfully by using an electrosurgical snare. Histological examination and immunohistochemical staining of the biopsy specimen from the duodenal lesion strongly supported the diagnosis of metastatic appendiceal adenocarcinoma.

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Ischemic enteritis with intestinal stenosis: Yorimitsu Koshikawa, Hiroshi Nakase, Minoru Matsuura, Takuya Yoshino, Yusuke Honzawa, Naoki Minami, Satoshi Yamada, Yumiko Yasuhara, Shigehiko Fujii, Toshihiro Kusaka, Dai Manaka, Hiroyuki Kokuryu; Intest Res 2016;14(1):89-95. Published online January 26, 2016; DOI: https://doi.org/10.5217/ir.2016.14.1.89

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A 75-year-old man was admitted to our hospital with sudden onset of vomiting and abdominal distension. The patient was taking medication for arrhythmia. Computed tomography showed stenosis of the ileum and a small bowel dilatation on the oral side from the region of stenosis. A transnasal ileus tube was placed. Enteroclysis using contrast medium revealed an approximately 6-cm afferent tubular stenosis 10 cm from the terminal ileum and thumbprinting in the proximal bowel. Transanal double-balloon enteroscopy showed a circumferential shallow ulcer with a smooth margin and edema of the surrounding mucosa. The stenosis was so extensive that we could not perform endoscopic balloon dilation therapy. During hospitalization, the patient's nutritional status deteriorated. In response, we surgically resected the region of stenosis. Histologic examination revealed disappearance of the mucosal layer and transmural ulceration with marked fibrosis, especially in the submucosal layer. Hemosiderin staining revealed sideroferous cells in the submucosal layers. Based on the pathologic findings, the patient was diagnosed with ischemic enteritis. The patient's postoperative course was uneventful.

Citations

Citations to this article as recorded by

Myeloid Sarcoma in the Small Intestine
Masaya Iwamuro, Tomohiro Kamio, Shoichiro Hirata, Katsunori Matsueda, Daisuke Kametaka, Takehiro Tanaka, Seiji Kawano, Motoyuki Otsuka
Internal Medicine.2025;[Epub] CrossRef
Spontaneous multiple small bowel perforations due to ischemic enteritis: a case report
Cheru Lilay Gebrehiwet, Aklilu Yiheyis Abereha, Dawit Aysheshim Mulualem, Misgana Lemma Gurmu, Samuel Addisu Abera, Amanuel Kassa Tadesse, Girma Damtew Adisu, Ermias Teklehaimanot Yefter, Melaku Tessema kassie
BMC Geriatrics.2025;[Epub] CrossRef
Late Graft Failure Due to Arterio-Venous Fistula in the Free Jejunal Graft Mesentery Following Total Pharyngo-Laryngo-Esophagectomy for Cervical Esophageal Cancer: A Case Report
Koutarou Yamamoto, Tomoyuki Okumura, Takeshi Miwa, Yoshihisa Numata, Tatsuhiro Araki, Ayaka Itoh, Mina Fukasawa, Nana Kimura, Masakazu Nagamori, Kosuke Mori, Naoya Takeda, Tomohiro Minagawa, Kenta Sukegawa, Toru Watanabe, Katsuhisa Hirano, Isaya Hashimoto
Surgical Case Reports.2025; 11(1): n/a. CrossRef
Clinical characteristics and surgical management of ileal strictures caused by ischemic enteritis: a report of three cases
Yuya Kondo, Shingo Tsujinaka, Tomoya Miura, Yoh Kitamura, Yoshihiro Sato, Kentaro Sawada, Atsushi Mitamura, Toru Nakano, Yu Katayose, Chikashi Shibata
Journal of Surgical Case Reports.2025;[Epub] CrossRef
Smooth muscle degeneration of the mesenteric and branching veins causing ischemic enteritis: a case report
Taiki Sunakawa, Nobuo Ito, Ryo Moriyasu, Nobuya Seki, Daisuke Takeuchi, Kotaro Sasahara
Surgical Case Reports.2022;[Epub] CrossRef
Ischemic enteritis resulting from polycythemia vera
Soichi Yagi, Kiyohide Kioka, Yurina Koizumi, Takashi Nakai, Yasuko Kawasaki, Minako Tsutsumi, Naomi Ishii, Tomoaki Yamasaki, Hiroko Nebiki, Kiyoshi Maeda
Clinical Journal of Gastroenterology.2022; 15(5): 907. CrossRef
Association of decreased variation of coefficient R–R interval with ischemic colitis and small bowel obstruction
Toshio Arai, Hiroki Yamada, Takeya Edagawa, Satoshi Yoshida, Shigetoshi Hikimoto, Hiromichi Sougawa, Kenichiro Nakachi, Raffaele Serra
PLOS ONE.2020; 15(2): e0228117. CrossRef
Ileítis isquémica idiopática, con sangrado digestivo oscuro manifiesto
Gabriel Mosquera-Klinger, Reinaldo Andrés Rincón
Gastroenterología y Hepatología.2019; 42(7): 439. CrossRef
Small bowel strictures
Deniz Durmush, Arthur J. Kaffes
Current Opinion in Gastroenterology.2019; 35(3): 235. CrossRef
Ultrasonographic and histopathological features in 8 cats with fibrotic small intestinal stricture
Andrew Holloway, Mauro Pivetta, Roberta Rasotto
Veterinary Radiology & Ultrasound.2019; 60(4): 423. CrossRef
Experience with Balloon Dilatation in Crohn’s and Non-Crohn’s Benign Small-Bowel Strictures: Is There a Difference?
Akiyoshi Tsuboi, Shiro Oka, Shinji Tanaka, Sumio Iio, Ichiro Otani, Sayoko Kunihara, Ryohei Hayashi, Kazuaki Chayama
Gastroenterology Research and Practice.2019; 2019: 1. CrossRef
Idiopathic ischaemic ileitis, with overt obscure digestive bleeding
Gabriel Mosquera-Klinger, Reinaldo Andrés Rincón
Gastroenterología y Hepatología (English Edition).2019; 42(7): 439. CrossRef
Stenotic Ischemic Enteritis with Concomitant Hepatic Portal Venous Gas and Pneumatosis Cystoides Intestinalis
Naoto Iwai, Osamu Handa, Yuji Naito, Osamu Dohi, Tetsuya Okayama, Naohisa Yoshida, Kazuhiro Kamada, Kazuhiko Uchiyama, Takeshi Ishikawa, Tomohisa Takagi, Hideyuki Konishi, Yoshito Itoh
Internal Medicine.2018; 57(14): 1995. CrossRef
Etiology and long‐term rebleeding of endoscopic ulcerative lesions in the small bowel in patients with obscure gastrointestinal bleeding: A multicenter cohort study
Tomonori Aoki, Atsuo Yamada, Yoshihiro Hirata, Hirobumi Suzuki, Ayako Nakada, Ryota Niikura, Motoko Seto, Makoto Okamoto, Kazuhiko Koike
Journal of Gastroenterology and Hepatology.2018; 33(7): 1327. CrossRef

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Small Bowel Metastatic Cancer Observed With Double Balloon Enteroscopy in a Patient With a Past History of Multiple Cancers: Ji Young Song, Beom Jae Lee, Eun Sang Yu, Young Ju Na, Jong-Jae Park, Jae Seon Kim, Young-Tae Bak; Intest Res 2015;13(4):350-354. Published online October 15, 2015; DOI: https://doi.org/10.5217/ir.2015.13.4.350

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Small bowel tumors are very rare and generally malignant. As a result of the anatomical location and nonspecific manifestations of small bowel tumors, they are very difficult to diagnose. Balloon-assisted enteroscopy is a relatively noninvasive method compared to surgical resection, and allows for real-time observation, tissue confirmation with biopsy, and interventional procedures. Here, we report the case of a 69-year-old woman with a small bowel metastatic carcinoma observed with double balloon enteroscopy (DBE). She had a history of multiple cancers including ovarian cancer, bladder cancer, and breast cancer. The antegrade DBE procedure was performed before surgery for biopsy tissue confirmation. The patient underwent small bowel resection, and the final diagnosis was the same as that determined by preoperative biopsy. The final diagnosis was metastatic small bowel cancer originating from a cancer of the breast. This is the first detailed report of the preoperative diagnosis of small intestinal metastatic breast cancer by DBE.

Citations

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Obscure Bleeding from a Metastatic Small Bowel Tumor Diagnosed Using Motorized Spiral Enteroscopy: A Case Study and a Literature Review
Christian Banciu, Andreea Munteanu, Adrian Aprotosoaie, Ramona Fabian, Amadeus Dobrescu, Adrian Vaduva, Antonio Fabian, Irina Soica, Viviana Ivan, Laurentiu Sima
Diagnostics.2024; 14(9): 904. CrossRef
Endoscopic and histological characteristics of small bowel tumors diagnosed by double-balloon enteroscopy
Suleyman Dolu, Soner Onem, Zarni Htway, Farid Hajıyev, Ali Bilgen, Hatice Cilem Binicier, Ecem Kalemoglu, Ozgul Sagol, Mesut Akarsu
Clinical Endoscopy.2023; 56(1): 83. CrossRef
Unusual cause of intestinal obstruction: Breast cancer with solitary ileal metastasis diagnosed after enteroscopy
Hsuan‐An Su, Chih‐Jung Chen, Hsu‐Heng Yen
Advances in Digestive Medicine.2017; 4(3): 110. CrossRef

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Original Article

Double-Balloon Enteroscopy in Elderly Patients: Is It Safe and Useful?: Dae Han Choi, Seong Ran Jeon, Jin-Oh Kim, Hyun Gun Kim, Tae Hee Lee, Woong Cheul Lee, Byung Soo Kang, Jun-Hyung Cho, Yunho Jung, Wan Jung Kim, Bong Min Ko, Joo Young Cho, Joon Seong Lee, Moon Sung Lee; Intest Res 2014;12(4):313-319. Published online October 27, 2014; DOI: https://doi.org/10.5217/ir.2014.12.4.313

Abstract PDF PubReader ePub

<b>Background/Aims</b><br/>

Providers may be hesitant to perform double-balloon enteroscopy (DBE) in the elderly because the increased number of co-morbidities in this population poses a greater risk of complications resulting from sedation. There are limited data on the use of DBE in the elderly. Here, we assessed the safety and efficacy of DBE in the elderly compared to those in younger patients.

Methods

We retrospectively analyzed the medical records of 158 patients who underwent 218 DBEs. Patients were divided into an elderly group (age ≥65 years; mean 71.4±5.4; n=34; 41 DBEs) and a younger group (age <65 years; mean 39.5±13.5; n=124; 177 DBEs).

Results

In both groups, the most common indication for DBE was obscure gastrointestinal bleeding. Mucosal lesions (33.3% vs. 60.9%; P=0.002) were the most common finding in both groups, followed by tumors (30.8% vs. 14.1%; P=0.036). The elderly were more likely to receive interventional therapy (51.3% vs. 23.5%; P=0.001). The diagnostic yield of DBE was slightly higher in the elderly group (92.3% vs. 86.5%; P=0.422), but was not statistically significant. The therapeutic success rate of DBE was 100% in the elderly group compared to 87.5% in the younger group (P=0.536). The overall DBE complication rate was 1.8% overall, and this rate did not differ significantly between the groups (2.6% vs. 1.7%; P=0.548).

Conclusions

DBE is safe and effective in the elderly, and has a high diagnostic yield and high therapeutic success rate.

Citations

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Rebecca K Grant, Alexander R Robertson, Kirsty A Lennon, Eksha Gupta, Ursula E Walton, Ross J Porter, Niall T Burke, Solomon Ong, Atul Anand, Sarah Douglas, Alice Corbett, William M Brindle, Rahul Kalla, John N Plevris
Frontline Gastroenterology.2025; 16(1): 30. CrossRef
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Margherita Trebbi, Cesare Casadei, Silvia Dari, Andrea Buzzi, Mario Brancaccio, Valentina Feletti, Alessandro Mussetto
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Enteroscopia de doble balón: indicaciones, abordajes, eficacia diagnóstica y terapéutica y seguridad. Experiencia temprana de un solo centro
J.J.E. García-Correa, J.J. Ramírez-García, L.F. García-Contreras, C. Fuentes-Orozco, L. Irusteta-Jiménez, L.R. Michel-Espinoza, A.S. Carballo Uribe, J.A. Torres Chávez, A. González-Ojeda
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Device-assisted enteroscopy in the UK: description of a large tertiary case series under conscious sedation
Vijay Pattni, David J Tate, Ana Terlevich, Peter Marden, Steve Hughes
Frontline Gastroenterology.2018; 9(2): 122. CrossRef
Paradigm shift: should the elderly undergo propofol sedation for DBE? A prospective cohort study
Hey-Long Ching, Federica Branchi, David S Sanders, David Turnbull, Reena Sidhu
Frontline Gastroenterology.2018; 9(3): 192. CrossRef
Efficacy and Safety of Single-Balloon Enteroscopy in Elderly Patients
Chen-Wang Chang, Ching-Wei Chang, Wei-Chen Lin, Chia-Hsien Wu, Horng-Yuan Wang, Tsang-En Wang, Cheng-Hsin Chu, Ming-Jen Chen
International Journal of Gerontology.2017; 11(3): 176. CrossRef
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Y. Chen, G. Liu, T. Zhang, K. Yang, H. Yu, Y. Tie, J. Liang, J. Zhou, H. Gan
European Geriatric Medicine.2017; 8(4): 354. CrossRef
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Seong Ran Jeon, Jeong‐Sik Byeon, Hyun Joo Jang, Soo Jung Park, Jong Pil Im, Eun Ran Kim, Ja Seol Koo, Bong Min Ko, Dong Kyung Chang, Jin‐Oh Kim, Su Yeon Park
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Systematic review: Safety of balloon assisted enteroscopy in Crohn’s disease
Ahilan Arulanandan, Parambir S Dulai, Siddharth Singh, William J Sandborn, Denise Kalmaz
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