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Double BALLOON ENDOSCOPY

Max Brinsmead MB BS PhD May 2019. Double BALLOON ENDOSCOPY. Problem. 76 year old male Caucasian with significant GIT haemorrhage No drugs/medication Colonoscopy and Oesaphogastroduodenoscopy negative Capsule Endoscopy (CE) GIT What might it find?

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Double BALLOON ENDOSCOPY

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  1. Max Brinsmead MB BS PhD May 2019 Double BALLOON ENDOSCOPY

  2. Problem • 76 year old male Caucasian with significant GIT haemorrhage • No drugs/medication • Colonoscopy and Oesaphogastroduodenoscopy negative • Capsule Endoscopy (CE) GIT • What might it find? • What are the chances it will find something? • What are the other options? • Relative merits of other investigations?

  3. Possible Causes of Small Intestinal Bleeding • Angiodysplasia 50 – 60% • Inflammatory lesions, ulcers and erosions • Includes Crohn’sdisease • Association with NSAID use • More common in Asian series • Polyp (5 – 10%) • Malignancy rare • Includes AdenoCa, Carcinoid and Lymphoma • Diverticula incl. Meckels • Active bleeding without focus

  4. Etiology of obscure gastro-intestinal bleeding according to age

  5. Angiodysplasia GIT

  6. Capsule Endoscopy

  7. Capsule Endoscopy • Capsule size 26 x 11 mm • Has colour camera, battery, light source and Transmitter • Data recorder worn as a belt • Transit time 24 – 48 hours • Takes 2 images/sec for 8 hours • Will generate 50,000 images • Retention rate 0.4 – 1.4% • Crohn’s is a relative contraindication • Will diagnose a lesion in about 66%

  8. Ray’s Capsule Endoscopy

  9. “Double Balloon Something or Other” • What is it? • How successful is it likely to be? • Risks and complications? • Other options?

  10. Double Balloon Endoscopy • Introduced by Yamamoto in 2001 • Allows complete visualization, biopsy and treatment of the small bowel • https://www.youtube.com/watch?v=7LYCtyvgBek

  11. Double Balloon Endoscopy • Essentially 100% successful with no learning curve • 75% antegrade • 25% retrograde • Takes 45 – 90 min • Can biopsy or snare polyps and argon laser angiodysplasia • Best done with CO2 insufflation • Complications more common with diseased bowel e.g Crohns

  12. Meta analysis of Capsule Endoscopy (CE) vs Double Balloon Endoscopy (DBE) • 712 patients in 12 studies • Similar diagnostic yields for both when investigating obscure GIT bleeding • DBE better for diagnosing diverticula • CE better for diagnosing fresh bleeding and clots • They are complimentary modalities • And sometimes simply repeating conventional endoscopy is required

  13. Other Options for Obscure GIT Bleeding • CT and angiography • Single balloon endosocopy • Spiral endoscopy • Operative endoscopy

  14. Please leave a Note on the Welcome Page to this Website Any Questions or Comments?

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