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Huimin Chen - One of the best experts on this subject based on the ideXlab platform.

  • a prospective study on evaluating the diagnostic yield of video capsule endoscopy followed by directed Double Balloon Enteroscopy in patients with obscure gastrointestinal bleeding
    Digestive Diseases and Sciences, 2010
    Co-Authors: Jun Dai, Yunjie Gao, Huimin Chen
    Abstract:

    Aims Video capsule endoscopy (VCE) and Double-Balloon Enteroscopy (DBE) are two novel methods for examining the small bowel and could be complementary to each other. The aim of the present study is to prospectively evaluate the diagnostic yield of VCE followed by a directed DBE in patients with obscure gastrointestinal (GI) bleeding.

  • a prospective study on evaluating the diagnostic yield of video capsule endoscopy followed by directed Double Balloon Enteroscopy in patients with obscure gastrointestinal bleeding
    Digestive Diseases and Sciences, 2010
    Co-Authors: Jun Dai, Yunjie Gao, Huimin Chen
    Abstract:

    Video capsule endoscopy (VCE) and Double-Balloon Enteroscopy (DBE) are two novel methods for examining the small bowel and could be complementary to each other. The aim of the present study is to prospectively evaluate the diagnostic yield of VCE followed by a directed DBE in patients with obscure gastrointestinal (GI) bleeding. Patients with obscure gastrointestinal bleeding for a complete VCE examination were involved in the study. DBE was recommended after a negative or indeterminate finding of VCE. The diagnostic and follow-up data were collected for analysis. A total of 190 patients with a complete VCE examination were enrolled in the study. The overall positive detection rate for small-bowel disease in the VCE group was 86.8% (165/190), while 63.7% (121/190) patients were definitely diagnosed. Fifty-one patients with indeterminate (44 cases) and negative (seven cases) findings of first VCE underwent DBE procedures. A total of 18 patients with negative VCE findings refused the further examination. DBE demonstrated a positive finding in 66.7% (34/51) patients, 33 from indeterminate group and one from the negative group. Following an unrevealing DBE, at surgical follow-up, three further negative DBE procedures were documented. The overall diagnostic yield was 88.9%, including 121 diagnoses made by VCE alone and 48 by both VCE and DBE (confirmed at surgery or other treatments). The negative predictive value (NPV) and positive predictive value (PPV) of DBE in indeterminate VCE were 81.8 and 100%, respectively. Capsule endoscopy followed by directed Double-Balloon Enteroscopy is a good strategy for investigating the causes of obscure GI bleeding and especially in confirming indeterminate and negative findings from VCE.

  • predictive role of capsule endoscopy on the insertion route of Double Balloon Enteroscopy
    Endoscopy, 2009
    Co-Authors: Huimin Chen, J Dai, Y J Gao
    Abstract:

    BACKGROUND AND STUDY AIMS: Double-Balloon Enteroscopy (DBE) has been suggested to be more efficient if based on the results of screening video capsule endoscopy (VCE). We evaluated the utility of VCE for predicting the best insertion route of DBE for the evaluation and treatment of small-bowel lesions. PATIENTS AND METHODS: Results of studies of patients with complete VCE examination of the small bowel and with findings confirmed by DBE are reported. A location index of lesions found on VCE was defined as the time from the pylorus to the lesion as a percentage of the time from the pylorus to the ileocecal valve. Based on our previous retrospective evaluation, a cut-off value of 0.6 was adopted, and the oral or anal approach was selected when the index was ≤ 0.6 or > 0.6, respectively. RESULTS: Data from 60 patients who underwent both VCE and DBE examinations and in whom the capsule reached the cecum were evaluated. Lesions shown on VCE were all reached by the first DBE procedures (41 orally and 19 anally). Based on the time index cut-off value of 0.6, the accuracy of selecting the insertion route of DBE was 100 %. CONCLUSION: DBE is an effective approach for confirming VCE results. In patients with complete small-bowel investigation by VCE, the best insertion route for DBE can be reliably indicated using a time index based on the VCE records.

Christian Ell - One of the best experts on this subject based on the ideXlab platform.

  • push and pull Enteroscopy using the Double Balloon technique Double Balloon Enteroscopy for the diagnosis of meckel s diverticulum in adult patients with gi bleeding of obscure origin
    The American Journal of Gastroenterology, 2006
    Co-Authors: Hendrik Manner, Lars Nachbar, Andrea May, Christian Ell
    Abstract:

    Push-and-Pull Enteroscopy Using the Double-Balloon Technique (Double-Balloon Enteroscopy) for the Diagnosis of Meckel's Diverticulum in Adult Patients with GI Bleeding of Obscure Origin

  • Double Balloon Enteroscopy push and pull Enteroscopy of the small bowel feasibility and diagnostic and therapeutic yield in patients with suspected small bowel disease
    Gastrointestinal Endoscopy, 2005
    Co-Authors: Andrea May, Lars Nachbar, Christian Ell
    Abstract:

    Background Double-Balloon Enteroscopy (push-and-pull Enteroscopy) is a new method that allows complete visualization, biopsy, and treatment in the small bowel. This study evaluated the feasibility and the diagnostic and the therapeutic yield of Double-Balloon Enteroscopy (push-and-pull Enteroscopy) in comparison with current imaging methods. Methods Between March 2003 and November 2004, 248 consecutive Double-Balloon enteroscopies (push-and-pull enteroscopies) were performed in a prospective study in 137 patients with suspected small-bowel disease (60 women, 77 men; mean age 56.6 ± 17.8 years), most with chronic GI bleeding (66%). The examinations were carried out after negative evaluations with other methods or to allow biopsy or treatment in patients with known small-bowel findings. Results There were no relevant technical problems or severe complications. On average, 240 ± 100 cm of the small bowel was visualized by using the oral route and 140 ± 90 cm was visualized by using the anal route. The investigation time averaged 73.5 ± 25 minutes. The overall diagnostic yield was 80% (109/137 patients). The main diagnosis was angiodysplasia (40/109; 37%); erosions and ulcerations of various etiologies were found in 27% (29/109). Polyps and tumors were identified, including malignancy, in 25% (27/109). Other findings were detected in a further 11%. No relevant pathology was found in 20%. Subsequent treatment was influenced by the results in 104 patients (76%): endoscopic therapy in 57 (41.5%), medical treatment in 23 (17%), and surgery in 24 (17.5%). Conclusions Double-Balloon Enteroscopy (push-and-pull Enteroscopy) is safe and easily conducted. Visualization and tissue sampling are possible in the entire small bowel by using the oral and anal approaches, and treatment is possible in the same way as in standard endoscopy, avoiding open surgery. If further prospective studies confirm its value, Double-Balloon Enteroscopy (push-and-pull Enteroscopy) may become a standard method of diagnostic and therapeutic endoscopy in the small bowel.

Andrea May - One of the best experts on this subject based on the ideXlab platform.

  • complications in Double Balloon Enteroscopy results of the german dbe register
    Zeitschrift Fur Gastroenterologie, 2008
    Co-Authors: O Moschler, Andrea May, M K Muller, C Ell
    Abstract:

    INTRODUCTION: The introduction of Double-Balloon Enteroscopy for the investigation of the small bowel in 2001 was a milestone in GI endoscopy because it allows us to carry out therapeutic interventions as well as diagnostic procedures in the small bowel. Because interventional procedures in endoscopy increase the risk of complications, e.g., in colonoscopy and only limited data were reported regarding the risk of DBE, we introduced a Double-Balloon Enteroscopy register (DBE Register) in Germany. AIM AND METHODS: The purpose of this study was to evaluate the complication rate of DBE in a larger group of patients. We contacted all endoscopic units using DBE in Germany in January 2006 and asked for their participation in the register, the examination data and their present complications beginning in January 2003 until 15.07.2006 using a questionnaire. RESULTS: The participation rate of 85 endoscopic centres using the DBE technique was 75 % (64 centres). They reported 3894 DBE examinations (2685 using the oral route, 1209 using the anal route) with 1086 interventions. 48 complications were reported (1.2 %). Acute pancreatitis occurred in 9 patients with 1 lethal course of disease, all of them receiving a DBE using the oral route. Thus, the pancreatitis rate after oral DBE was 0.34 %. Perforation happened in 8 cases, all of them needed surgery. One patient died during the course of the disease. 6 perforations occurred after polypectomy, so the perforation rate after polypectomy during DBE is 3.4 % in this study. In 6 cases major bleeding was reported, 4 in the context of polypectomy and 2 after biopsy. All patients received endoscopic treatment and recovered from this complication. CONCLUSION: DBE is in this by now largest collection of cases a safe endoscopic procedure with an overall complication rate of approximately 1%. For diagnostic DBE pancreatitis is the most frequent complication and has to be taken in consideration in the written informed consent.

  • push and pull Enteroscopy using the Double Balloon technique Double Balloon Enteroscopy
    Digestive and Liver Disease, 2006
    Co-Authors: Andrea May, C Ell
    Abstract:

    Abstract Push-and-Pull Enteroscopy/Double Balloon Enteroscopy (PPE/DBE) allows Enteroscopy of the entire small bowel, or at least a substantial part of it. The complication rate is acceptably low. Severe complications such as pancreatitis and perforation were encountered in the literature in approximately 1% of all diagnostic PPE/DBEs. It can be expected that the complication rate of therapeutic PPE/DBEs is higher, comparable with the conventional endoscopy. The diagnostic yield is high, at approximately 75%, as is the therapeutic yield. The option of carrying out endoscopic therapy (in approximately 40%–50% of cases in the Western hemisphere) is an important aspect. Angiodysplasias are the main bleeding source, at least in Western countries. Using the PPE/DBE device, endoscopic treatments such as endoscopic hemostasis using injection and argon plasma coagulation, polypectomy, endoscopic resection, Balloon dilation, and foreign-body extraction have become feasible even in the small intestine and can generally be performed safely and without relevant technical problems. Medical therapy can be started in up to 20% of cases—e.g., after a new or changed diagnosis of Crohn's disease. Surgical therapy is required in 10–20% of cases, due to malignant tumors or complex stenoses, for example. The main indication is mid-gastrointestinal bleeding.

  • push and pull Enteroscopy using the Double Balloon technique Double Balloon Enteroscopy for the diagnosis of meckel s diverticulum in adult patients with gi bleeding of obscure origin
    The American Journal of Gastroenterology, 2006
    Co-Authors: Hendrik Manner, Lars Nachbar, Andrea May, Christian Ell
    Abstract:

    Push-and-Pull Enteroscopy Using the Double-Balloon Technique (Double-Balloon Enteroscopy) for the Diagnosis of Meckel's Diverticulum in Adult Patients with GI Bleeding of Obscure Origin

  • Double Balloon Enteroscopy push and pull Enteroscopy of the small bowel feasibility and diagnostic and therapeutic yield in patients with suspected small bowel disease
    Gastrointestinal Endoscopy, 2005
    Co-Authors: Andrea May, Lars Nachbar, Christian Ell
    Abstract:

    Background Double-Balloon Enteroscopy (push-and-pull Enteroscopy) is a new method that allows complete visualization, biopsy, and treatment in the small bowel. This study evaluated the feasibility and the diagnostic and the therapeutic yield of Double-Balloon Enteroscopy (push-and-pull Enteroscopy) in comparison with current imaging methods. Methods Between March 2003 and November 2004, 248 consecutive Double-Balloon enteroscopies (push-and-pull enteroscopies) were performed in a prospective study in 137 patients with suspected small-bowel disease (60 women, 77 men; mean age 56.6 ± 17.8 years), most with chronic GI bleeding (66%). The examinations were carried out after negative evaluations with other methods or to allow biopsy or treatment in patients with known small-bowel findings. Results There were no relevant technical problems or severe complications. On average, 240 ± 100 cm of the small bowel was visualized by using the oral route and 140 ± 90 cm was visualized by using the anal route. The investigation time averaged 73.5 ± 25 minutes. The overall diagnostic yield was 80% (109/137 patients). The main diagnosis was angiodysplasia (40/109; 37%); erosions and ulcerations of various etiologies were found in 27% (29/109). Polyps and tumors were identified, including malignancy, in 25% (27/109). Other findings were detected in a further 11%. No relevant pathology was found in 20%. Subsequent treatment was influenced by the results in 104 patients (76%): endoscopic therapy in 57 (41.5%), medical treatment in 23 (17%), and surgery in 24 (17.5%). Conclusions Double-Balloon Enteroscopy (push-and-pull Enteroscopy) is safe and easily conducted. Visualization and tissue sampling are possible in the entire small bowel by using the oral and anal approaches, and treatment is possible in the same way as in standard endoscopy, avoiding open surgery. If further prospective studies confirm its value, Double-Balloon Enteroscopy (push-and-pull Enteroscopy) may become a standard method of diagnostic and therapeutic endoscopy in the small bowel.

Lars Nachbar - One of the best experts on this subject based on the ideXlab platform.

Jun Dai - One of the best experts on this subject based on the ideXlab platform.

  • a prospective study on evaluating the diagnostic yield of video capsule endoscopy followed by directed Double Balloon Enteroscopy in patients with obscure gastrointestinal bleeding
    Digestive Diseases and Sciences, 2010
    Co-Authors: Jun Dai, Yunjie Gao, Huimin Chen
    Abstract:

    Aims Video capsule endoscopy (VCE) and Double-Balloon Enteroscopy (DBE) are two novel methods for examining the small bowel and could be complementary to each other. The aim of the present study is to prospectively evaluate the diagnostic yield of VCE followed by a directed DBE in patients with obscure gastrointestinal (GI) bleeding.

  • a prospective study on evaluating the diagnostic yield of video capsule endoscopy followed by directed Double Balloon Enteroscopy in patients with obscure gastrointestinal bleeding
    Digestive Diseases and Sciences, 2010
    Co-Authors: Jun Dai, Yunjie Gao, Huimin Chen
    Abstract:

    Video capsule endoscopy (VCE) and Double-Balloon Enteroscopy (DBE) are two novel methods for examining the small bowel and could be complementary to each other. The aim of the present study is to prospectively evaluate the diagnostic yield of VCE followed by a directed DBE in patients with obscure gastrointestinal (GI) bleeding. Patients with obscure gastrointestinal bleeding for a complete VCE examination were involved in the study. DBE was recommended after a negative or indeterminate finding of VCE. The diagnostic and follow-up data were collected for analysis. A total of 190 patients with a complete VCE examination were enrolled in the study. The overall positive detection rate for small-bowel disease in the VCE group was 86.8% (165/190), while 63.7% (121/190) patients were definitely diagnosed. Fifty-one patients with indeterminate (44 cases) and negative (seven cases) findings of first VCE underwent DBE procedures. A total of 18 patients with negative VCE findings refused the further examination. DBE demonstrated a positive finding in 66.7% (34/51) patients, 33 from indeterminate group and one from the negative group. Following an unrevealing DBE, at surgical follow-up, three further negative DBE procedures were documented. The overall diagnostic yield was 88.9%, including 121 diagnoses made by VCE alone and 48 by both VCE and DBE (confirmed at surgery or other treatments). The negative predictive value (NPV) and positive predictive value (PPV) of DBE in indeterminate VCE were 81.8 and 100%, respectively. Capsule endoscopy followed by directed Double-Balloon Enteroscopy is a good strategy for investigating the causes of obscure GI bleeding and especially in confirming indeterminate and negative findings from VCE.