Clinical Endoscopy

Review

Single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: a technical review: Yuki Tanisaka, Masafumi Mizuide, Akashi Fujita, Rie Shiomi, Takahiro Shin, Kei Sugimoto, Shomei Ryozawa; Clin Endosc 2023;56(6):716-725. Published online April 17, 2023; DOI: https://doi.org/10.5946/ce.2023.023

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Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is technically challenging. For example, scope insertion, selective cannulation, and intended procedures, such as stone extraction or stent placement, can be difficult. Single-balloon enteroscopy (SBE)-assisted ERCP has been used to effectively and safely address these technical issues in clinical practice. However, the small working channel limits its therapeutic potential. To address this shortcoming, a short-type SBE (short SBE) with a working length of 152 cm and a channel of 3.2 mm diameter has recently been introduced. Short SBE facilitates the use of larger accessories to complete certain procedures, such as stone extraction or self-expandable metallic stent placement. Despite the development in the SBE endoscope, various steps have to be overcome to successfully perform such procedure. To improve success, the challenging factors of each procedure must be identified. At the same time, endoscopists need to be mindful of adverse events, such as perforation, which can arise due to adhesions specific to the surgically altered anatomy. This review discussed technical tips regarding SBE-assisted ERCP in patients with surgically altered anatomy to increase success and reduce the risk of adverse events associated with ERCP.

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Advanced technical tips and recent insights in ERCP using balloon‐assisted endoscopy
Masaaki Shimatani, Toshiyuki Mitsuyama, Takeshi Yamashina, Masahiro Takeo, Shunsuke Horitani, Natsuko Saito, Hironao Matsumoto, Masahiro Orino, Masataka Kano, Takafumi Yuba, Takuya Takayama, Tatsuya Nakagawa, Shoji Takayama
DEN Open.2024;[Epub] CrossRef
Efficacy of texture and color enhancement imaging for short‐type single‐balloon enteroscopy‐assisted biliary cannulation in patients with Roux‐en‐Y gastrectomy: Multicenter study (with video)
Yuki Tanisaka, Mamoru Takenaka, Masafumi Mizuide, Akashi Fujita, Ryuhei Jinushi, Takahiro Shin, Kei Sugimoto, Ken Kamata, Kosuke Minaga, Shunsuke Omoto, Tomohiro Yamazaki, Shomei Ryozawa
Digestive Endoscopy.2024; 36(9): 1030. CrossRef
Progress in minimally invasive treatment of biliary pancreatic duct obstruction after digestive tract reconstruction by endoscopic retrograde cholangiopancreatography
Ru-Yi Wang, Zhen Fan
World Chinese Journal of Digestology.2024; 32(7): 490. CrossRef
Endoscopic Management of Biliary and Pancreatic Pathologies in Roux-en-Y Gastric Bypass Patients: Development of a Treatment Algorithm Based on 9-Year Experience
Laurent Monino, Lancelot Marique, Yannick Deswysen, Maximilien Thoma, Pierre H. Deprez, Pierre Goffette, Benoit Navez, Tom G. Moreels
Obesity Surgery.2024; 34(10): 3717. CrossRef
Use of short single-balloon enteroscopy in patients with surgically altered anatomy: a single-center experience
Songming Ding, Shanjie Dong, Hengkai Zhu, Yiting Hu, Shusen Zheng, Qiyong Li
Scientific Reports.2024;[Epub] CrossRef
Development and evaluation of artificial organ models for ERCP training in patients with surgically altered anatomies
Kai Koch, Benedikt Duckworth-Mothes, Ulrich Schweizer, Karl-Ernst Grund, Tom G. Moreels, Alfred Königsrainer, Dörte Wichmann
Scientific Reports.2023;[Epub] CrossRef
Simplified single-session EUS-guided transhepatic antegrade stone removal for management of choledocholithiasis in patients with surgically altered anatomy
Tingting Yu, Suning Hou, Haiming Du, Wei Zhang, Jiao Tian, Yankun Hou, Jun Yao, Senlin Hou, Lichao Zhang
Gastroenterology Report.2023;[Epub] CrossRef

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Focused Review Series: Training in Endoscopy

Training in Endoscopy: Enteroscopy: Jinsu Kim; Clin Endosc 2017;50(4):328-333. Published online July 31, 2017; DOI: https://doi.org/10.5946/ce.2017.089

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The balloon-assisted enteroscope has been regarded as the standard device for direct visualization of deep small bowels and allows for the diagnosis and treatment of small bowel disease. At the beginning, its application was focused on the diagnosis of obscure gastrointestinal bleeding, inflammatory bowel disease, and small bowel tumor. However, the indications are being expanded to various therapeutic procedures, not only confined to bleeding control. With the expansion of the indications, the need to perform enteroscopy effectively and safely is increasing. Recent studies have been focused on the diagnostic yield, therapeutic yield, and long-term outcomes of the device. However, with the increasing number of procedures, procedural guidelines and quality indicators are also needed.

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Performance of pan‐enteroscopy in children with intestinal failure due to short bowel syndrome: A single‐center retrospective study
Jonathan A. Salazar, Christina Chan, Enju Liu, Fatima Hamroud, Amit S. Grover, Victor L. Fox, Peter D. Ngo, Lissette Jimenez, Christopher P. Duggan, Alexandra N. Carey
Journal of Pediatric Gastroenterology and Nutrition.2024; 79(4): 915. CrossRef
Research Progress of the Use of Balloon-Assisted Enteroscopy (BAE) in Small Bowel Diseases
芸玲李
Advances in Clinical Medicine.2024; 14(09): 555. CrossRef
The Role of Endoscopy in the Diagnosis and Management of Small Bowel Pathology in Children
Amornluck Krasaelap, Diana G. Lerner, Salvatore Oliva
Gastrointestinal Endoscopy Clinics of North America.2023; 33(2): 423. CrossRef
A systematic review of symptomatic hamartomas of the jejunum and ileum
N Farkas, M Conroy, M Baig
The Annals of The Royal College of Surgeons of England.2022; 104(1): 18. CrossRef
Clinicopathological Features of Small Bowel Tumors Diagnosed by Video Capsule Endoscopy and Balloon-Assisted Enteroscopy: A Single Center Experience
Ah Young Yoo, Beom Jae Lee, Won Shik Kim, Seong Min Kim, Seung Han Kim, Moon Kyung Joo, Hyo Jung Kim, Jong-Jae Park
Clinical Endoscopy.2021; 54(1): 85. CrossRef
Device-assisted enteroscopy training. A rapid review
Federico Soria Gálvez, Octavio López-Albors, Pilar Esteban Delgado, Enrique Pérez-Cuadrado Robles, Rafael Latorre Reviriego
Revista Española de Enfermedades Digestivas.2020;[Epub] CrossRef
Balloon-Assisted Enteroscopy for Retrieval of Small Intestinal Foreign Bodies: A KASID Multicenter Study
Jeongseok Kim, Beom Jae Lee, Nam Seok Ham, Eun Hye Oh, Kee Don Choi, Byong Duk Ye, Jeong-Sik Byeon, Chang Soo Eun, Jin Su Kim, Dong-Hoon Yang
Gastroenterology Research and Practice.2020; 2020: 1. CrossRef
Enteroscopy in children and adults with inflammatory bowel disease
Giovanni Di Nardo, Gianluca Esposito, Chiara Ziparo, Federica Micheli, Luigi Masoni, Maria Pia Villa, Pasquale Parisi, Maria Beatrice Manca, Flavia Baccini, Vito Domenico Corleto
World Journal of Gastroenterology.2020; 26(39): 5944. CrossRef
Enteroscopy in children
Giovanni Di Nardo, Carlo Calabrese, Roberto Conti Nibali, Arianna De Matteis, Emanuele Casciani, Luigi Martemucci, Giuseppe Pagliaro, Nico Pagano
United European Gastroenterology Journal.2018; 6(7): 961. CrossRef
Motorized Spiral Enteroscopy for Occult Bleeding
Laura Mans, Marianna Arvanitakis, Horst Neuhaus, Jacques Devière
Digestive Diseases.2018; 36(4): 325. CrossRef
Comprehensive review of outcomes of endoscopic treatment of gastrointestinal bleeding
Tae-Geun Gweon, Jinsu Kim
International Journal of Gastrointestinal Intervention.2018; 7(3): 123. CrossRef
Balloon-Assisted Enteroscopy and Capsule Endoscopy in Suspected Small Bowel Crohn’s Disease
Hsu-Heng Yen, Chen-Wang Chang, Jen-Wei Chou, Shu-Chen Wei
Clinical Endoscopy.2017; 50(5): 417. CrossRef

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Case Report

A Case of Primary Small Bowel Melanoma Diagnosed by Single-Balloon Enteroscopy: Jun Young Shin, In Suh Park, Byoung Wook Bang, Hyung Kil Kim, Yong Woon Shin, Kye Sook Kwon; Clin Endosc 2017;50(4):395-399. Published online June 2, 2017; DOI: https://doi.org/10.5946/ce.2016.153

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Although metastasis from cutaneous malignant melanoma to the small intestine is not uncommon, primary small bowel melanoma (SBM) is extremely rare. This case report describes a rare case of primary SBM, diagnosed by single-balloon enteroscopy. A 74-year-old man presented with recurrent melena. Upper endoscopy and colonoscopy were unremarkable. Abdominal computed tomography (CT) revealed an ileal mass with ileo-ileal intussusception. Subsequent single-balloon enteroscopy identified an ileal tumor, which was histologically diagnosed as melanoma. Extensive clinical examination did not reveal any primary cutaneous lesions. To the best of our knowledge, this is the first case of primary SBM in South Korea.

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Primary malignant melanoma of the small bowel: A case report
James R. Marak, Tushant Kumar, Shivam Dwivedi, Shashwat Verma
Radiology Case Reports.2024; 19(3): 1215. CrossRef
Small bowel melanoma causing obstruction: A case report and a literature review
Ammar Mattit, Ibrahim Marrawi, Safouh Kheir, Taha Khamis, Safaa Qatleesh, Muhammad Ali Ousta
International Journal of Surgery Case Reports.2024; 116: 109388. CrossRef
Small Bowel Intussusception Secondary to Malignant Melanoma 11 Years After Melanoma-In-Situ Excision
W. Eric Briscoe, W. Todd Cockerham, Kevin N. Harrell
The American Surgeon™.2023; 89(7): 3275. CrossRef
Primary Small Bowel Melanoma: A Case Report and Review of Literature
Amanda M. Graças, Willy P. Souza, Ana Carolina A. Canut, Maurice Y. Franciss, Bruno Zilberstein
Frontiers in Surgery.2022;[Epub] CrossRef
Primary jejunal amelanotic melanoma: case report and review of literature
Kavya M. Reddy, Tinashe Maduke, Francis Wade, Christine Hachem
Clinical Journal of Gastroenterology.2021; 14(5): 1376. CrossRef
Effect of Double-Balloon Enteroscopy on Diagnosis and Treatment of Small-Bowel Diseases
Li Tang, Liu-Ye Huang, Jun Cui, Cheng-Rong Wu
Chinese Medical Journal.2018; 131(11): 1321. CrossRef

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Special Issue Article of IDEN 2013

Deep Enteroscopy: Which Technique Will Survive?: Seong Ran Jeon, Jin-Oh Kim; Clin Endosc 2013;46(5):480-485. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.480

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The advent of deep enteroscopy (DE) has dramatically changed diagnostic and therapeutic approaches to small bowel diseases. Unlike capsule endoscopy, which is unable to obtain biopsies or treat a disease, DE techniques have diagnostic and therapeutic capabilities. Double-balloon enteroscopy (DBE) was introduced in 2001, and single-balloon enteroscopy (SBE) and spiral enteroscopy (SE) were subsequently developed for small bowel investigation. In published reports comparing these different enteroscopy techniques, most comparative parameters (depth of insertion, complications, learning curve, diagnostic yield, and therapeutic yield) were comparable among DBE, SBE, and SE. However, the procedure duration appears to be shorter for SE than for DBE and SBE. The rate of complete enteroscopy is clearly superior for DBE, compared with SE and SBE. Because these results do not indicate an increase in diagnostic or therapeutic yield, the clinical impact of complete enteroscopy remains controversial. According to previous studies, the three DE methods seem to be equally effective and safe in the clinical setting. Although larger randomized controlled trials are needed to evaluate the procedural characteristics and clinical impact, the selection of an enteroscopic technique should be based on availability and the endoscopist's experience.

Citations

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Use of Device-Assisted Enteroscopy in Small Bowel Disease: An Expert Consensus Statement by the Korean Association for the Study of Intestinal Diseases
Han Hee Lee, Jin Su Kim, Hyeon Jeong Goong, Shin Hee Lee, Eun Hye Oh, Jihye Park, Min Cheol Kim, Kwangwoo Nam, Young Joo Yang, Tae Jun Kim, Seung-Joo Nam, Hee Seok Moon, Jae Hyun Kim, Duk Hwan Kim, Seong-Eun Kim, Seong Ran Jeon, Seung-Jae Myung
The Korean Journal of Gastroenterology.2023; 81(1): 1. CrossRef
Three cases of jejunal tumors detected by standard upper gastrointestinal endoscopy: A case series
Jaesun Lee, Sunmoon Kim, Daesung Kim, Sangeok Lee, Kihyun Ryu
World Journal of Clinical Cases.2023; 11(4): 962. CrossRef
Use of device-assisted enteroscopy in small bowel disease: an expert consensus statement by the Korean Association for the Study of Intestinal Diseases
Han Hee Lee, Jin Su Kim, Hyeon Jeong Goong, Shin Hee Lee, Eun Hye Oh, Jihye Park, Min Cheol Kim, Kwangwoo Nam, Young Joo Yang, Tae Jun Kim, Seung-Joo Nam, Hee Seok Moon, Jae Hyun Kim, Duk Hwan Kim, Seong-Eun Kim, Seong Ran Jeon, Seung-Jae Myung
Intestinal Research.2023; 21(1): 3. CrossRef
Achieving Total Enteroscopy by Consecutive Bidirectional Double-balloon Enteroscopy Procedures
Liang Zhao, An-ning Yin, Fei Liao, Yi-juan Ding, Hong-gang Yu
Current Medical Science.2022; 42(1): 144. CrossRef
Enteroscopia de doble balón: experiencia inicial en un hospital universitario
Arecio Peñaloza Ramírez, Jonathan Barreto Pérez, Fabio Sierra Matamoros, Esteban Coral Argoty, María Alejandra Castro Rodríguez, Pedro Nel Aponte Ordoñez
Revista colombiana de Gastroenterología.2021; 36(3): 327. CrossRef
Device-assisted enteroscopy training. A rapid review
Federico Soria Gálvez, Octavio López-Albors, Pilar Esteban Delgado, Enrique Pérez-Cuadrado Robles, Rafael Latorre Reviriego
Revista Española de Enfermedades Digestivas.2020;[Epub] CrossRef
Complete anterograde small-bowel exploration with the novel motorized spiral enteroscope
Begoña González-Suárez, Antonio Giordano, Miriam Escapa, Josep Llach
VideoGIE.2020; 5(11): 517. CrossRef
Small bowel bleeding
Stefania Chetcuti Zammit, Reena Sidhu
Current Opinion in Gastroenterology.2018; 34(3): 165. 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
ANALYSIS OF DOUBLE BALLOON ENTEROSCOPY: INDICATIONS, FINDINGS, THERAPEUTIC AND COMPLICATIONS
Flávio Heuta IVANO, Izabela Rodrigues VILLELA, Lívia Fouani de MIRANDA, Thaísa Sami NAKADOMARI
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo).2017; 30(2): 83. CrossRef
Endoscopy in the Diagnosis and Management of Complications of Inflammatory Bowel Disease
Benjamin Tharian, Nayana George, Udayakumar Navaneethan
Inflammatory Bowel Diseases.2016; 22(5): 1184. CrossRef
Comparison of double-balloon and single-balloon enteroscope for therapeutic endoscopic retrograde cholangiography after Roux-en-Y small bowel surgery
Michael De Koning, Tom G. Moreels
BMC Gastroenterology.2016;[Epub] CrossRef
Enteroscopy
Shailendra S. Chauhan, Michael A. Manfredi, Barham K. Abu Dayyeh, Brintha K. Enestvedt, Larissa L. Fujii-Lau, Sri Komanduri, Vani Konda, John T. Maple, Faris M. Murad, Rahul Pannala, Nirav C. Thosani, Subhas Banerjee
Gastrointestinal Endoscopy.2015; 82(6): 975. CrossRef
Deep enteroscopy with a conventional colonoscope: initial multicenter study by using a through-the-scope balloon catheter system
Rabia Ali, Daniel Wild, Frederick Shieh, David L. Diehl, Monika Fischer, Wataru Tamura, David T. Rubin, Vivek Kumbhari, Patrick Okolo, Andrew Storm, Zamir Halpern, Helmut Neumann, Harshit S. Khara, Mark B. Pochapin, Seth A. Gross
Gastrointestinal Endoscopy.2015; 82(5): 855. CrossRef
Small bowel intervention and application of enteroscopy for altered small bowel anatomy—endoscopic advanced therapy using double balloon enteroscopy
Masaaki Shimatani, Norimasa Fukata, Ryo Suzuki, Sachi Miyamoto, Kota Kato, Toshiyuki Mitsuyama, Hideaki Miyoshi, Tsukasa Ikeura, Makoto Takaoka, Kazuichi Okazaki
Gastrointestinal Intervention.2014; 3(2): 69. CrossRef
Palliative enteroscopic stent placement for malignant mid-gut obstruction
Esha Baichoo, Louis M. Wong Kee Song
Gastrointestinal Intervention.2014; 3(1): 30. CrossRef

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A Case of Capillary Hemangioma in the Jejunum Detected by Single Balloon Enteroscopy in a Patient with Anemia: Jun-Hyung Cho, M.D., Jae Young Jang, M.D., Chang Hyun Cho, M.D., Jaejun Shim, M.D., Seok Ho Dong, M.D., Hyo Jong Kim, M.D., Byung-Ho Kim, M.D. and Young Woon Chang, M.D.; Korean J Gastrointest Endosc 2011;42(4):263-267. Published online April 28, 2011

Abstract PDF: Hemangiomas are uncommon benign vascular tumors that account for up to 10% of all small bowel tumors. The jejunum is the most common location, and gastrointestinal bleeding is a frequent clinical presentation. Histologically, hemangiomas are classified as cavernous, capillary, or mixed types. Capillary hemangiomas are dense collections of capillaries usually with a hyperplastic endothelium. There have been a few cases of small bowel capillary hemangioma revealed by capsule endoscopy and confirmed after surgical resection. But preoperative detection of hemangiomas in the small intestine has not been reported, as far as we know, associated with the use of balloon-assisted enteroscopy. This report describes a 44-year-old male with a small bowel mass considered to be a cause of severe iron deficiency anemia. In this case, we performed capsule endoscopy and single balloon enteroscopy to examine the lesion. The patient then underwent a segmental resection of the jejunum, which confirmed the presence of a capillary hemangioma with surface ulceration. (Korean J Gastrointest Endosc 2011;42: 263-267)

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A Case of Jejunal Extranodal MALT Lymphoma Diagnosed by Single-balloon Enteroscopy: Son Ook Choi, M.D., Jung Sun Bag, M.D., Sok Won Han, M.D., Chang Whan Kim, M.D., Tae Ho Kim, M.D., Min Kuk Kim, M.D. and Hwang Choi, M.D.; Korean J Gastrointest Endosc 2010;41(4):245-250. Published online October 30, 2010

Abstract PDF: Small bowel lesions located in long and multiple complex loop configurations were difficult to diagnose early because of vague clinical manifestations and because of the poor diagnostic yield of conventional examination methods. In this setting, double-balloon enteroscopy (DBE) was an epoch-making diagnostic and therapeutic tool for the management of patients with small bowel disease. Single-balloon enteroscopy (SBE), lacking a balloon at the endoscopic tip, is also a useful method for investigating and managing suspected small bowel lesions. Mucosa associated lymphoid tissue (MALT) lymphoma of the small bowel is relatively uncommon and remains a localized disease for long periods in most patients. Recently, we experienced a case of advanced-stage MALT lymphoma in the jejunum. A 60-year old female, with a history of anemia of unknown etiology and who was suspected of having a small bowel lesion, presented with complaints of vague abdominal pain and dizziness. She had undergone SBE via the oral route. She was diagnosed with MALT lymphoma of the jejunum and treated with medical management. (Korean J Gastrointest Endosc 2010;41:245-250)

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