Complete double-balloon enteroscopy: from A 2 E

 CommentaryCREST syndrome is defined by calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia. The telangiectasia of hereditary hemorrhagic telangiectasia and of the CREST variant of scleroderma may be indistinguishable, so diagnosis of CREST syndrome is based on the associated features of the syndrome as well as the presence of antinuclear and anticentromere antibodies. Telangiectasia of the stomach, small intestine, or both is a common cause of occult GI bleeding, although such lesions in the small intestine may be particularly difficult to find. Not only are telangiectasias less visible in the face of anemia or hypotension and after use of meperidine, but their locations deep within the small bowel had rendered them hidden—that is until the development of double-balloon enteroscopy. Dr. Haber certainly is an expert in double-balloon enteroscopy, and his technique in this case reminds me of two things: First are the adventures of the early pioneers of colonoscopy in their quests to view the proximal colon. One such experience was that of Provencale and Revignas, who, in 1969, passed a string per os, allowed it to exit the rectum, and then attached the colonoscope and pulled it into the proximal bowel. The colon was viewed upon exiting it and, I am sure, their withdrawal time exceeded the 6 minutes recommended today. Second is the Søren Kierkegaard quotation that life must be understood backward but lived forward. In this case, going backward certainly helped this patient's care to move forward.Lawrence J. Brandt, MDAssociate Editor for Focal Points

PII: S0016-5107(09)02711-4

doi:10.1016/j.gie.2009.10.057

© 2010 Published by Elsevier Inc.