Background
Small-bowel enteroscopies (BEs) are tedious and prolonged, and their efficacy may
be affected by the timing of procedures.
Objective
We aimed to evaluate the differences in diagnostic yield, insertion depth, procedure
duration, therapeutic yield, and adverse events (AEs) of enteroscopies performed in
the morning versus the afternoon.
Design
Retrospective cohort study.
Setting
Tertiary referral center.
Patients
Patients who underwent BE for suspected small-bowel disease at a single institution
between January 2008 and August 2009.
Main Outcome Measurement
Differences in diagnostic yield, insertion depth, procedure duration, therapeutic
yield, and AEs between morning (started before noon) and afternoon (after noon) procedures.
Results
A total of 250 enteroscopies were performed on 250 patients, of which 125 patients
(50%) underwent a procedure in the morning and 125 patients (50%) underwent the procedure
in the afternoon. The diagnostic yield with anterograde enteroscopy was the same in
both the morning and afternoon (63.7% and 63.7%, respectively; P = .99). The procedure durations were also similar (42.4 ± 21.5 minutes vs 46.2 ±
22.4 minutes, respectively; P = .25). Similarly the diagnostic yield with retrograde enteroscopy was similar in
morning and afternoon (44.1% and 35.3%, respectively; P = .46). However, the procedure durations of retrograde BE were significantly shorter
in the morning compared with the afternoon (51.3 ± 21.3 minutes vs 66.6 ± 32.9 minutes,
respectively; P = .03). Therapeutic yield and AEs were similar.
Limitations
Retrospective study.
Conclusions
The timing of procedure, morning versus afternoon, did not affect the diagnostic and
therapeutic efficacy of BE in patients with suspected small-bowel disease.
Abbreviations:
APC (argon plasma coagulation), AE (adverse event), BE (small-bowel enteroscopy), DBE (double-balloon enteroscopy), SBE (single-balloon enteroscopy), SE (spiral enteroscopy)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Adenomas are detected more often in morning than in afternoon colonoscopy.Am J Gastroenterol. 2009; 104: 1659-1664
- Fewer polyps detected by colonoscopy as the day progresses at a Veteran's Administration teaching hospital.Clin Gastroenterol Hepatol. 2009; 7: 1217-1223
- Afternoon colonoscopies have higher failure rates than morning colonoscopies.Am J Gastroenterol. 2006; 101: 2726-2730
- Comparison of morning versus afternoon cecal intubation rates.BMC Gastroenterol. 2007; 7: 19
- Total enteroscopy with a nonsurgical steerable double-balloon method.Gastrointest Endosc. 2001; 53: 216-220
- Spiral enteroscopy with the new DSB overtube: a novel technique for deep peroral small-bowel intubation.Endoscopy. 2008; 40: 974-978
- What is the learning curve associated with double-balloon enteroscopy?.Gastrointest Endosc. 2006; 64: 740-750
- Antegrade is more effective than retrograde enteroscopy for evaluation and management of suspected small-bowel disease.Clin Gastroenterol Hepatol. 2012; 10: 910-916
- Endoscopic interventions in the small bowel using double balloon enteroscopy: feasibility and limitations.Am J Gastroenterol. 2007; 102: 527-535
- Push-and-pull enteroscopy using the double-balloon technique: method of assessing depth of insertion and training of the enteroscopy technique using the Erlangen Endo-Trainer.Endoscopy. 2005; 37: 66-70
- A lexicon for endoscopic adverse events: report of an ASGE workshop.Gastrointest Endosc. 2010; 71: 446-454
- Patient safety: fatigue among clinicians and the safety of patients.N Engl J Med. 2002; 347: 1249-1255
- Fatigue in anesthesia: implications and strategies for patient and provider safety.Anesthesiology. 2002; 97: 1281-1294
- Effect of sleep deprivation on the performance of simulated laparoscopic surgical skill.Am J Surg. 2003; 186: 169-174
- Adenoma detection rate is not influenced by the timing of colonoscopy when performed in half-day blocks.Am J Gastroenterol. 2011; 106: 1466-1471
- Risk of hyperamylasemia and acute pancreatitis after double-balloon enteroscopy: a prospective study.Endoscopy. 2011; 43: 766-770
- Association of hyperamylasemia and longer duration of peroral double-balloon enteroscopy: present and future.Gastrointest Endosc. 2008; 68: 811
- Hyperamylasemia of uncertain significance associated with oral double-balloon enteroscopy.Gastrointest Endosc. 2007; 66: 1133-1138
- Deep sedation occurs frequently during elective endoscopy with meperidine and midazolam.Am J Gastroenterol. 2005; 100: 2689-2695
- Effect of the time of day on the success and adverse events of ERCP.Gastrointest Endosc. 2011; 74: 303-308
- Spiral enteroscopy: a novel method of enteroscopy by using the Endo-Ease Discovery SB overtube and a pediatric colonoscope.Gastrointest Endosc. 2009; 69: 327-332
- A comparative evaluation of single-balloon enteroscopy and spiral enteroscopy for patients with mid-gut disorders.Gastrointest Endosc. 2010; 72: 766-772
- Single balloon enteroscopy might be more effective than double balloon and spiral enteroscopy in the evaluation and management of small bowel disease [abstract].Gastrointest Endosc. 2010; 71: AB368-AB369
- Success rate of retrograde double-balloon enteroscopy.Gastrointest Endosc. 2007; 65: 633-639
- Double-balloon enteroscopy (push-and-pull enteroscopy) of the small bowel: feasibility and diagnostic and therapeutic yield in patients with suspected small bowel disease.Gastrointest Endosc. 2005; 62: 62-70
- Double-balloon enteroscopy: indications, diagnostic yield, and complications in a series of 275 patients with suspected small-bowel disease.Endoscopy. 2006; 38: 42-48
- Initial experience with double-balloon enteroscopy at a U.S. center.Gastrointest Endosc. 2008; 67: 890-897
- Novel single-balloon enteroscopy for diagnosis and treatment of the small intestine: preliminary experiences.Endoscopy. 2008; 40: 11-15
- Technical matters in double balloon enteroscopy.Gastrointest Endosc. 2007; 66: S15-S18
Article info
Publication history
Accepted:
August 27,
2012
Received:
July 2,
2012
Footnotes
DISCLOSURE: The authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Sanaka at [email protected]
Identification
Copyright
© 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.