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Diagnostics
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Device-Assisted Enteroscopy: An Update on Diagnostic and Therapeutic Approaches
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Device-Assisted Enteroscopy: An Update on Diagnostic and Therapeutic Approaches

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (11 November 2022) | Viewed by 11746

Special Issue Editor

Prof. Dr. Seong Ran Jeon

E-Mail Website
Guest Editor
Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-Gu, Seoul 04401, Korea
Interests: device-assited enteroscopy; small bowel disease; lesion detection; new technology

Special Issue Information

Dear Colleagues,

The advent of device-assisted enteroscopy (DAE) has remarkably changed diagnostic and therapeutic approaches to small bowel diseases. Alongside consolidated indications such as the diagnosis and treatment of small bowel bleeding, Crohn's disease, and small bowel tumors, DAE is nowadays widely used to perform endoscopic retrograde cholangiopancreatography in patients with postsurgical altered anatomy, to perform stenting, and to retrieve foreign bodies; additionally, it is used in selected cases of incomplete colonoscopy. The overall complication rate of DAE is low and acceptable, and its safety profile is favorable even in elderly patients. DAE is currently an effective alternative to major surgery. The evolution of enteroscopy is challenging for the future and could be facilitated by new enteroscope models. The forthcoming Special Issue focuses on recent updates on diagnostic and therapeutic approaches.

Prof. Dr. Seong Ran Jeon
Guest Editor

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Keywords

  • Device-assisted enteroscopy
  • Expanded indication
  • Diagnostic yield
  • Clinical impact
  • Therapeutic intervention
  • Safety
  • New enteroscopes

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Published Papers (5 papers)

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11 pages, 901 KiB  
Article
Indication, Location of the Lesion, Diagnostic Yield, and Therapeutic Yield of Double-Balloon Enteroscopy: Seventeen Years of Experience
by Sang Pyo Lee, Hyun Joo Jang, Sea Hyub Kae, Jae Gon Lee and Ji Hye Kwon
Diagnostics 2022, 12(9), 2224; https://doi.org/10.3390/diagnostics12092224 - 14 Sep 2022
Cited by 10 | Viewed by 2469
Abstract
Double-balloon enteroscopy (DBE) has become one of the standard methods in the diagnosis and treatment of small bowel (SB) disease. However, previous studies for DBE have limitations due to heterogeneity of indications and operators. The aim was to investigate the indication, location of [...] Read more.
Double-balloon enteroscopy (DBE) has become one of the standard methods in the diagnosis and treatment of small bowel (SB) disease. However, previous studies for DBE have limitations due to heterogeneity of indications and operators. The aim was to investigate the indication, location of the lesion, diagnostic yield, and therapeutic yield of DBE based on long-term data from a single operator. A retrospective study was performed by reviewing medical records of subjects who had received DBE at our unit in the past 17 years. Overall diagnostic yield was 78.7% (210/267). The diagnostic yield for obscure gastrointestinal bleeding (OGIB) was 68.3% (84/123). The diagnostic yield for OGIB was significantly lower (p < 0.001) than that for other indications. Therapeutic yield was 24.7% (66/267). Complications occurred in 7 (2.6%). Crohn’s disease, intestinal tuberculosis, nonsteroidal anti-inflammatory drug enteropathy, and diverticular lesions were mainly found in the ileum. Vascular lesions, non-specific inflammation, and neoplastic lesions were found more frequently in the jejunum. DBE is an excellent and safe endoscopic method for the diagnosis and treatment of SB lesions. DBE has a lower diagnostic rate for OGIB than for other indications. The location where a lesion is commonly found depends on the type of the lesion. Full article
(This article belongs to the Special Issue Device-Assisted Enteroscopy: An Update on Diagnostic and Therapeutic Approaches)
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10 pages, 663 KiB  
Article
Histological Diagnostic Yield and Clinical Significance of the First Biopsy in Device-Assisted Enteroscopy in Patients with Small Bowel Diseases: A KASID Multicenter Study
by Hyeon Jeong Goong, Tae Joon Kim, Kwangwoo Nam, Jihye Park, Jin-Oh Kim, Hyun Gun Kim, Bong Min Ko, Seong Ran Jeon and Small Intestine Research Group of the Korean Association for the Study of Intestinal Diseases (KASID)
Diagnostics 2022, 12(4), 964; https://doi.org/10.3390/diagnostics12040964 - 12 Apr 2022
Cited by 1 | Viewed by 2007
Abstract
Device-assisted enteroscopy (DAE) enables the direct visualization of small bowel lesions with histological diagnosis; however, few studies have described the diagnostic performance of enteroscopic biopsy. We investigated the diagnostic performance of enteroscopic biopsy. We used a nationwide multicenter enteroscopy database to identify patients [...] Read more.
Device-assisted enteroscopy (DAE) enables the direct visualization of small bowel lesions with histological diagnosis; however, few studies have described the diagnostic performance of enteroscopic biopsy. We investigated the diagnostic performance of enteroscopic biopsy. We used a nationwide multicenter enteroscopy database to identify patients who underwent DAE with biopsy for small bowel diseases. The patients were classified into the tumor and non-tumor groups according to the final diagnosis. They were also divided into diagnostic and non-diagnostic groups based on the enteroscopic biopsy results. The clinical significance of the first biopsy and histological diagnostic yield of DAE were analyzed. Among the 112 procedures investigated, 32 (28.9%) were diagnosed with tumors, and 80 (71.7%) were diagnosed with non-tumor diseases. The overall histological diagnostic yield of DAE was 43.7%. The histological diagnostic yield was significantly higher in the tumor than in the non-tumor group (81.2% vs. 28.8%, p < 0.001). The mean number of biopsies was significantly higher in the diagnostic than in the non-diagnostic group (5.6 ± 3.3 vs. 3.7 ± 2.1, p = 0.001). In the diagnostic group, 87.7% of the cases were histologically confirmed at the first biopsy. Therefore, the first biopsy should be performed carefully. Full article
(This article belongs to the Special Issue Device-Assisted Enteroscopy: An Update on Diagnostic and Therapeutic Approaches)
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9 pages, 688 KiB  
Article
Rebleeding Rate and Risk Factors for Rebleeding after Device-Assisted Enteroscopy in Patients with Obscure Gastrointestinal Bleeding: A KASID Multicenter Study
by Yuna Kim, Jae-Hyun Kim, Eun-Ae Kang, Soo-Jung Park, Jae-Jun Park, Jae-Hee Cheon, Tae-Il Kim, Jihye Park and Seong-Ran Jeon
Diagnostics 2022, 12(4), 954; https://doi.org/10.3390/diagnostics12040954 - 11 Apr 2022
Cited by 6 | Viewed by 2113
Abstract
Introduction: The impact of device-assisted enteroscopy (DAE) on long-term rebleeding in patients with obscure gastrointestinal bleeding (OGIB) exhibiting detectable small-bowel lesions remains unclear. We investigated the long-term rebleeding rate and predictive factors for DAE in patients with OGIB. Method: Patients with OGIB with [...] Read more.
Introduction: The impact of device-assisted enteroscopy (DAE) on long-term rebleeding in patients with obscure gastrointestinal bleeding (OGIB) exhibiting detectable small-bowel lesions remains unclear. We investigated the long-term rebleeding rate and predictive factors for DAE in patients with OGIB. Method: Patients with OGIB with small bowel lesions detected through DAE were enrolled at three Korean tertiary hospitals. Predictive risk factors associated with rebleeding were analyzed using the Cox regression analysis. Results: From April 2008 to April 2021, 141 patients were enrolled, including 38 patients (27.0%) with rebleeding. The rebleeding rates at 1, 2, and 3 years were 25.0%, 29.6%, and 31.1%, respectively. The Cox regression analysis revealed that multiple small-bowel lesions (hazard ratio [HR]: 2.551, 95% confidence interval [CI]: 1.157–5.627, p = 0.020), the need for more than five packed red blood cells (RBC) transfusions (HR: 2.704, 95% CI: 1.412–5.181, p = 0.003), and ulcerative lesions (HR: 1.992, 95% CI: 1.037–3.826, p = 0.039) were positively associated with rebleeding. Therapeutic interventions for patients with detectable lesions, overt bleeding (vs. occult bleeding), comorbidities, and medications were not associated with rebleeding. Conclusion: More than 25% of patients with OGIB having detectable small-bowel lesions had rebleeding. Patients with multiple lesions, a requirement of more than five packed RBC transfusions, and ulcerative lesions were associated with a higher risk of rebleeding. Full article
(This article belongs to the Special Issue Device-Assisted Enteroscopy: An Update on Diagnostic and Therapeutic Approaches)
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7 pages, 391 KiB  
Article
Factors Affecting Route Selection of Balloon-Assisted Enteroscopy in Patients with Obscure Gastrointestinal Bleeding: A KASID Multicenter Study
by 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 and Sung Hoon Jung
Diagnostics 2021, 11(10), 1860; https://doi.org/10.3390/diagnostics11101860 - 10 Oct 2021
Cited by 3 | Viewed by 2462
Abstract
Balloon-assisted enteroscopy (BAE) is an important diagnostic modality for ongoing obscure gastrointestinal bleeding (OGIB). However, it is difficult to determine the optimal insertion route. We retrospectively analyzed the records of patients with OGIB contained in a multicenter enteroscopy database of 1108 balloon-assisted enteroscopy [...] Read more.
Balloon-assisted enteroscopy (BAE) is an important diagnostic modality for ongoing obscure gastrointestinal bleeding (OGIB). However, it is difficult to determine the optimal insertion route. We retrospectively analyzed the records of patients with OGIB contained in a multicenter enteroscopy database of 1108 balloon-assisted enteroscopy (BAE) procedures (875 patients) to find out factors affecting BAE route selection in patients with OGIB. A total of 603 BAE procedures in 512 patients were investigated: there were 392 (65.0%) bidirectional and 211 (35.0%) unidirectional procedures. Overt OGIB was more frequent in the latter group (p = 0.024). Computed tomography (CT) was more frequently performed in the unidirectional group (p < 0.001). Capsule endoscopy and a small bowel barium study were performed more frequently in the bidirectional group (p < 0.001 and p = 0.039, respectively). Multivariate analysis showed that occult OGIB, capsule endoscopy and a small bowel barium study were independently associated with use of the bidirectional approach (p = 0.011, p = 0.013 and p = 0.046, respectively). Conversely, CT was associated with use of the unidirectional approach (p < 0.001). Conclusion: CT can aid the selection of an optimal insertion route in OGIB patients. However, capsule endoscopy and small bowel barium study are unhelpful. Full article
(This article belongs to the Special Issue Device-Assisted Enteroscopy: An Update on Diagnostic and Therapeutic Approaches)
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2 pages, 4992 KiB  
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Bleeding Lesion from Roux-en-Y Hepaticojejunostomy: A Successful Combined Hemostasis with Dual Emission Laser 1.9/1.5 μm
by Beatrice Marinoni, Luca Elli, Gian Eugenio Tontini, Lucia Scaramella, Roberto Penagini, Maurizio Vecchi and Nicoletta Nandi
Diagnostics 2022, 12(9), 2107; https://doi.org/10.3390/diagnostics12092107 - 30 Aug 2022
Cited by 1 | Viewed by 1613
Abstract
A 28-year-old woman, with a history of liver transplantation with Roux-en-Y hepaticjejunostomy, was admitted for melena and severe anemia. Bidirectional endoscopy was normal. Capsule endoscopy demonstrated fresh blood in the efferent limb downstream of the jejuno-jejunostomy. Anterograde double-balloon enteroscopy (DBE) showed an adherent [...] Read more.
A 28-year-old woman, with a history of liver transplantation with Roux-en-Y hepaticjejunostomy, was admitted for melena and severe anemia. Bidirectional endoscopy was normal. Capsule endoscopy demonstrated fresh blood in the efferent limb downstream of the jejuno-jejunostomy. Anterograde double-balloon enteroscopy (DBE) showed an adherent clot with a visible vessel oozing next to the hepaticojejunostomy. Bleeding was treated firstly with argon plasma coagulation and endoclips and further treated with dual emission laser, achieving complete hemostasis. At the 3 months follow-up, hemoglobin was stable without evidence of re-bleeding. Full article
(This article belongs to the Special Issue Device-Assisted Enteroscopy: An Update on Diagnostic and Therapeutic Approaches)
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