Safety and efficacy of double-balloon enteroscopy in pediatric patients

Background

Although double-balloon enteroscopy (DBE) is performed increasingly often in adults, few findings are available on the use of DBE in pediatric patients in the published literature.

Objectives

The aim of our study was to evaluate the safety and efficacy of DBE in pediatric patients.

Design

A retrospective database review.

Setting and Patients

A database analysis was performed on all pediatric patients (18 years old or younger) who underwent DBE at the Jichi Medical University Hospital between September 2000 and October 2008 selected from a total of 825 patients.

Main Outcome Measurements

Clinical utility and safety of DBE in pediatric patients.

Results

A total of 92 procedures were performed in 48 patients (27 male, 21 female) with a median age (range) of 12.2 (4-18) years. DBE was performed with the patients under general anesthesia in 43 procedures and under moderate sedation in 49 procedures. The most common indication for DBE was treatment of a stricture of a biliary anastomosis after living-donor liver transplantation with establishment of Roux-en-Y hepaticojejunostomy (23 patients). Endoscopic retrograde cholangiography using DBE was performed, and endoscopic therapy could be performed successfully in 13 (56%) patients. The second most common indication was obscure GI bleeding (10 patients); the lesions responsible for the bleeding were found in 7 (70%) patients. Other indications included surveillance and treatment of hereditary polyposis syndromes (5 patients), abdominal pain (4 patients), and inflammatory bowel disease (2 patients). The overall diagnostic yield was 65% (31 of the 48 patients). Postpolypectomy bleeding occurred in 1 case, but no other complications such as perforation and pancreatitis were observed.

Limitations

Small number of patients, participation bias, and single center's experience.

Conclusions

DBE is a safe and clinically useful endoscopic procedure in pediatric patients.

Abbreviations: CE, capsule endoscopy, DBE, double-balloon enteroscopy, ERC, endoscopic retrograde cholangiography