The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Christian Ell - One of the best experts on this subject based on the ideXlab platform.
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prospective cross over single center trial comparing oral double balloon Enteroscopy and oral spiral Enteroscopy in patients with suspected small bowel vascular malformations
Endoscopy, 2011Co-Authors: Andrea May, Hendrik Manner, I Aschmoneit, Christian EllAbstract:BACKGROUND AND STUDY AIMS: Spiral Enteroscopy is a new, promising rapid Enteroscopy technique. A prospective cross-over study was carried out to compare this new method with the established technique of double-balloon Enteroscopy (DBE). PATIENTS AND METHODS: From an initial group of 18 patients with suspected mid-gastrointestinal bleeding due to vascular malformations but no previous history of small-bowel or colonic surgery, 10 patients (mean age 69 years) completed the study. Patients underwent both Enteroscopy techniques with an oral approach, in a randomized sequence. The deepest point reached during advancement in the first Enteroscopy was marked with India ink. The primary end point of the study was the total examination time. RESULTS: For spiral Enteroscopy, the mean examination time was significantly shorter than with DBE (43 minutes vs. 65 minutes; P = 0.007), as was the mean time required for advancement of the enteroscope to the deepest point (24 minutes vs. 43 minutes; P = 0.03). However, the median maximum insertion depth was greater in the DBE group than in the spiral Enteroscopy group (310 cm vs. 250 cm; P = 0.004). In all cases in which DBE followed spiral Enteroscopy, DBE passed the India ink mark by a mean of over 100 cm. When DBE was performed first, spiral Enteroscopy was either unable to reach the mark or else unable to advance deeper into the small bowel. No severe complications occurred. CONCLUSIONS: The results confirm that the new spiral Enteroscopy technique reduces the examination time, although the insertion depth with DBE is at present superior.
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diagnostic and therapeutic yield of push and pull Enteroscopy for symptomatic small bowel crohn s disease strictures
European Journal of Gastroenterology & Hepatology, 2007Co-Authors: J Pohl, Lars Nachbar, Andrea May, Christian EllAbstract:Objective Crohn's disease is frequently complicated by obstructive symptoms secondary to small bowel strictures that cannot be accessed by conventional endoscopy. Push-and-pull Enteroscopy is a new endoscopic tool that might allow not only diagnostic work-up but also therapeutic interventions of these strictures. The purpose of this study was to evaluate the feasibility and safety of push-and-pull Enteroscopy in the treatment of symptomatic small bowel Crohn's disease strictures. Methods Between September 2003 and May 2006, 19 consecutive patients with known or suspected Crohn's disease and symptomatic small bowel strictures were subjected to push-and-pull Enteroscopy and included in our analysis. Results With push-and-pull Enteroscopy at least one small bowel stricture was accessed in each patient. On the basis of endoscopic assessment strictures in nine patients were not amenable to endoscopic therapy because of anatomical reasons (3/9) or severe inflammatory activity within the stenotic segment (6/9). They underwent direct surgery or intensified immunomodulatory treatment, respectively. In 10 patients with 13 strictures we performed 15 dilations in combination with push-and-pull Enteroscopy under fluoroscopic guidance. Technical success was achieved in 8/10 patients, symptomatic relief with avoidance of surgery was achieved in 6/10 patients who remained symptom free during a mean follow-up period of 10 months (range, 4-16 months). No complications were encountered after dilation. Conclusions Push-and-pull Enteroscopy is very useful for diagnosis and directing therapy in patients with Crohn's disease-associated strictures within the small bowel. Balloon dilation with the push-and-pull Enteroscopy device appears safe and effective and can be considered as an alternative to surgery in selected patients with medically refractory strictures.
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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, 2006Co-Authors: Hendrik Manner, Lars Nachbar, Andrea May, Christian EllAbstract: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
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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, 2005Co-Authors: Andrea May, Lars Nachbar, Christian EllAbstract: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.
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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, 2005Co-Authors: A May, Lars Nachbar, Marion Schneider, M Neumann, Christian EllAbstract:Background and Study Aims: This study was conducted to test a method of measuring the depth of insertion into the small bowel during push-and-pull Enteroscopy using the Erlangen Endo-Trainer. Furthermore, the Erlangen Endo-Trainer model for training in the new method of push-and-pull Enteroscopy using the double-balloon technique was also evaluated. Materials and Methods: Specially prepared packages of porcine upper visceral organs were used, including the esophagus, stomach, duodenum, and small bowel, implanted into the Erlangen Endo-Trainer. In the first step of this study, all of the modifications needed to obtain a model useful for training in the new Enteroscopy technique were tested, including different lengths of small bowel. In the next step, the Erlangen Endo-Trainer was used to evaluate a special method of measuring the depth of insertion during push-and-pull Enteroscopy by comparing estimated insertion depths of 100 cm and 200 cm, marked on the porcine small bowel, with endoscopic insertion depths determined afterwards by measuring the length of the small bowel from the pylorus to the mark on the porcine small bowel. Additionally, the Endotrainer was used to demonstrate the principle of double-balloon Enteroscopy and to provide training in this new Enteroscopy technique with a lifelike simulation. Results: The modified Erlangen Endo-Trainer proved its value for demonstrating the principle of push-and-pull Enteroscopy and for providing training in this enteroscopic technique as well as for testing the measurement method. The evaluation of the measurement method showed that the estimation of the insertion depths was accurate, with a mean deviation of less than 10%. A total of 13 workshops (seven national and six international), including a total of 97 participants, were carried out between January and August 2004. Under the supervision of one of the authors, pairs of trainees were able to reach the ileal valve or the end of the small bowel from the oral route. Conclusions: The modified Erlangen Endo-Trainer is useful for training in the push-and-pull Enteroscopy technique. The new specially developed method of measuring the depth of insertion during push-and-pull Enteroscopy seems to be valid.
Lars Nachbar - One of the best experts on this subject based on the ideXlab platform.
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diagnostic and therapeutic yield of push and pull Enteroscopy for symptomatic small bowel crohn s disease strictures
European Journal of Gastroenterology & Hepatology, 2007Co-Authors: J Pohl, Lars Nachbar, Andrea May, Christian EllAbstract:Objective Crohn's disease is frequently complicated by obstructive symptoms secondary to small bowel strictures that cannot be accessed by conventional endoscopy. Push-and-pull Enteroscopy is a new endoscopic tool that might allow not only diagnostic work-up but also therapeutic interventions of these strictures. The purpose of this study was to evaluate the feasibility and safety of push-and-pull Enteroscopy in the treatment of symptomatic small bowel Crohn's disease strictures. Methods Between September 2003 and May 2006, 19 consecutive patients with known or suspected Crohn's disease and symptomatic small bowel strictures were subjected to push-and-pull Enteroscopy and included in our analysis. Results With push-and-pull Enteroscopy at least one small bowel stricture was accessed in each patient. On the basis of endoscopic assessment strictures in nine patients were not amenable to endoscopic therapy because of anatomical reasons (3/9) or severe inflammatory activity within the stenotic segment (6/9). They underwent direct surgery or intensified immunomodulatory treatment, respectively. In 10 patients with 13 strictures we performed 15 dilations in combination with push-and-pull Enteroscopy under fluoroscopic guidance. Technical success was achieved in 8/10 patients, symptomatic relief with avoidance of surgery was achieved in 6/10 patients who remained symptom free during a mean follow-up period of 10 months (range, 4-16 months). No complications were encountered after dilation. Conclusions Push-and-pull Enteroscopy is very useful for diagnosis and directing therapy in patients with Crohn's disease-associated strictures within the small bowel. Balloon dilation with the push-and-pull Enteroscopy device appears safe and effective and can be considered as an alternative to surgery in selected patients with medically refractory strictures.
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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, 2006Co-Authors: Hendrik Manner, Lars Nachbar, Andrea May, Christian EllAbstract: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
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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, 2005Co-Authors: Andrea May, Lars Nachbar, Christian EllAbstract: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.
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extraction of entrapped capsules from the small bowel by means of push and pull Enteroscopy with the double balloon technique
Endoscopy, 2005Co-Authors: Andrea May, Lars Nachbar, C EllAbstract:The new technique of push-and-pull Enteroscopy using the double-balloon technique (double-balloon Enteroscopy) makes it possible to remove swallowed foreign bodies causing intestinal obstruction deep in the small bowel without the need for surgical laparotomy. This report describes two cases of enteroscopic removal of entrapped capsules. In one patient with acute recurrent intestinal bleeding and recurrent abdominal pain, Crohn's disease had been suspected on capsule endoscopy. The second patient, with known Crohn's disease, was suffering from abdominal pain and underwent capsule endoscopy for investigation of the small bowel. Prior enteroclysis had not revealed stenoses in either patient. An oral approach was chosen and the capsules were identified approximately 140 cm and 310 cm from the pylorus, respectively, in front of stenoses. The capsule endoscopes were removed successfully in both patients by means of push-and-pull Enteroscopy using a new enteroscope device.
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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, 2005Co-Authors: A May, Lars Nachbar, Marion Schneider, M Neumann, Christian EllAbstract:Background and Study Aims: This study was conducted to test a method of measuring the depth of insertion into the small bowel during push-and-pull Enteroscopy using the Erlangen Endo-Trainer. Furthermore, the Erlangen Endo-Trainer model for training in the new method of push-and-pull Enteroscopy using the double-balloon technique was also evaluated. Materials and Methods: Specially prepared packages of porcine upper visceral organs were used, including the esophagus, stomach, duodenum, and small bowel, implanted into the Erlangen Endo-Trainer. In the first step of this study, all of the modifications needed to obtain a model useful for training in the new Enteroscopy technique were tested, including different lengths of small bowel. In the next step, the Erlangen Endo-Trainer was used to evaluate a special method of measuring the depth of insertion during push-and-pull Enteroscopy by comparing estimated insertion depths of 100 cm and 200 cm, marked on the porcine small bowel, with endoscopic insertion depths determined afterwards by measuring the length of the small bowel from the pylorus to the mark on the porcine small bowel. Additionally, the Endotrainer was used to demonstrate the principle of double-balloon Enteroscopy and to provide training in this new Enteroscopy technique with a lifelike simulation. Results: The modified Erlangen Endo-Trainer proved its value for demonstrating the principle of push-and-pull Enteroscopy and for providing training in this enteroscopic technique as well as for testing the measurement method. The evaluation of the measurement method showed that the estimation of the insertion depths was accurate, with a mean deviation of less than 10%. A total of 13 workshops (seven national and six international), including a total of 97 participants, were carried out between January and August 2004. Under the supervision of one of the authors, pairs of trainees were able to reach the ileal valve or the end of the small bowel from the oral route. Conclusions: The modified Erlangen Endo-Trainer is useful for training in the push-and-pull Enteroscopy technique. The new specially developed method of measuring the depth of insertion during push-and-pull Enteroscopy seems to be valid.
Andrea May - One of the best experts on this subject based on the ideXlab platform.
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small bowel capsule endoscopy and device assisted Enteroscopy for diagnosis and treatment of small bowel disorders european society of gastrointestinal endoscopy esge clinical guideline
Endoscopy, 2015Co-Authors: Marco Pennazio, Samuel N. Adler, Andrea May, Cristiano Spada, Rami Eliakim, Martin Keuchel, Chris J J Mulder, Emanuele Rondonotti, J G Albert, Peter BaltesAbstract:Small-bowel capsule endoscopy (SBCE) 1 ESGE recommends that prior to SBCE patients ingest a purgative (2 L of polyethylene glycol [PEG]) for better visualization. Strong recommendation, high quality evidence. However, the optimal timing for taking purgatives is yet to be established. 2 ESGE recommends that SBCE should be performed as an outpatient procedure if possible, since completion rates are higher in outpatients than in inpatients. Strong recommendation, moderate quality evidence. 3 ESGE recommends that patients with pacemakers can safely undergo SBCE without special precautions. Strong recommendation, low quality evidence. 4 ESGE suggests that SBCE can also be safely performed in patients with implantable cardioverter defibrillators and left ventricular assist devices. Weak recommendation, low quality evidence. 5 ESGE recommends the acceptance of qualified nurses and trained technicians as prereaders of capsule endoscopy studies as their competency in identifying pathology is similar to that of medically qualified readers. The responsibility of establishing a diagnosis must however remain with the attending physician. Strong recommendation, moderate quality evidence. 6 ESGE recommends observation in cases of asymptomatic capsule retention. Strong recommendation, moderate quality evidence. In cases where capsule retrieval is indicated, ESGE recommends the use of device-assisted Enteroscopy as the method of choice. Strong recommendation, moderate quality evidence. Device-assisted Enteroscopy (DAE) 1 ESGE recommends performing diagnostic DAE as a day-case procedure in patients without significant underlying co-morbidities; in patients with co-morbidities and/or those undergoing a therapeutic procedure, an inpatient stay is recommended. Strong recommendation, low quality evidence The choice between different settings also depends on sedation protocols. Strong recommendation, low quality evidence. 2 ESGE suggests that conscious sedation, deep sedation, and general anesthesia are all acceptable alternatives: the choice between them should be governed by procedure complexity, clinical factors, and local organizational protocols. Weak recommendation, low quality evidence. 3 ESGE recommends that the findings of previous diagnostic investigations should guide the choice of insertion route. Strong recommendation, moderate quality evidence. If the location of the small-bowel lesion is unknown or uncertain, ESGE recommends that the antegrade route should be generally preferred. Strong recommendation, low quality evidence. In the setting of massive overt bleeding, ESGE recommends an initial antegrade approach. Strong recommendation, low quality evidence. 4 ESGE recommends that, for balloon-assisted Enteroscopy (i. e., single-balloon Enteroscopy [SBE] and double-balloon Enteroscopy [DBE]), small-bowel insertion depth should be estimated by counting net advancement of the enteroscope during the insertion phase, with confirmation of this estimate during withdrawal. Strong recommendation, low quality evidence. ESGE recommends that, for spiral Enteroscopy, insertion depth should be estimated during withdrawal. Strong recommendation, moderate quality evidence. Since the calculated insertion depth is only a rough estimate, ESGE recommends placing a tattoo to mark the identified lesion and/or the deepest point of insertion. Strong recommendation, low quality evidence. 5 ESGE recommends that all endoscopic therapeutic procedures can be undertaken at the time of DAE. Strong recommendation, moderate quality evidence. Moreover, when therapeutic interventions are performed, additional specific safety measures are needed to prevent complications. Strong recommendation, high quality evidence.
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prospective cross over single center trial comparing oral double balloon Enteroscopy and oral spiral Enteroscopy in patients with suspected small bowel vascular malformations
Endoscopy, 2011Co-Authors: Andrea May, Hendrik Manner, I Aschmoneit, Christian EllAbstract:BACKGROUND AND STUDY AIMS: Spiral Enteroscopy is a new, promising rapid Enteroscopy technique. A prospective cross-over study was carried out to compare this new method with the established technique of double-balloon Enteroscopy (DBE). PATIENTS AND METHODS: From an initial group of 18 patients with suspected mid-gastrointestinal bleeding due to vascular malformations but no previous history of small-bowel or colonic surgery, 10 patients (mean age 69 years) completed the study. Patients underwent both Enteroscopy techniques with an oral approach, in a randomized sequence. The deepest point reached during advancement in the first Enteroscopy was marked with India ink. The primary end point of the study was the total examination time. RESULTS: For spiral Enteroscopy, the mean examination time was significantly shorter than with DBE (43 minutes vs. 65 minutes; P = 0.007), as was the mean time required for advancement of the enteroscope to the deepest point (24 minutes vs. 43 minutes; P = 0.03). However, the median maximum insertion depth was greater in the DBE group than in the spiral Enteroscopy group (310 cm vs. 250 cm; P = 0.004). In all cases in which DBE followed spiral Enteroscopy, DBE passed the India ink mark by a mean of over 100 cm. When DBE was performed first, spiral Enteroscopy was either unable to reach the mark or else unable to advance deeper into the small bowel. No severe complications occurred. CONCLUSIONS: The results confirm that the new spiral Enteroscopy technique reduces the examination time, although the insertion depth with DBE is at present superior.
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diagnostic and therapeutic yield of push and pull Enteroscopy for symptomatic small bowel crohn s disease strictures
European Journal of Gastroenterology & Hepatology, 2007Co-Authors: J Pohl, Lars Nachbar, Andrea May, Christian EllAbstract:Objective Crohn's disease is frequently complicated by obstructive symptoms secondary to small bowel strictures that cannot be accessed by conventional endoscopy. Push-and-pull Enteroscopy is a new endoscopic tool that might allow not only diagnostic work-up but also therapeutic interventions of these strictures. The purpose of this study was to evaluate the feasibility and safety of push-and-pull Enteroscopy in the treatment of symptomatic small bowel Crohn's disease strictures. Methods Between September 2003 and May 2006, 19 consecutive patients with known or suspected Crohn's disease and symptomatic small bowel strictures were subjected to push-and-pull Enteroscopy and included in our analysis. Results With push-and-pull Enteroscopy at least one small bowel stricture was accessed in each patient. On the basis of endoscopic assessment strictures in nine patients were not amenable to endoscopic therapy because of anatomical reasons (3/9) or severe inflammatory activity within the stenotic segment (6/9). They underwent direct surgery or intensified immunomodulatory treatment, respectively. In 10 patients with 13 strictures we performed 15 dilations in combination with push-and-pull Enteroscopy under fluoroscopic guidance. Technical success was achieved in 8/10 patients, symptomatic relief with avoidance of surgery was achieved in 6/10 patients who remained symptom free during a mean follow-up period of 10 months (range, 4-16 months). No complications were encountered after dilation. Conclusions Push-and-pull Enteroscopy is very useful for diagnosis and directing therapy in patients with Crohn's disease-associated strictures within the small bowel. Balloon dilation with the push-and-pull Enteroscopy device appears safe and effective and can be considered as an alternative to surgery in selected patients with medically refractory strictures.
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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, 2006Co-Authors: Hendrik Manner, Lars Nachbar, Andrea May, Christian EllAbstract: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
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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, 2005Co-Authors: Andrea May, Lars Nachbar, Christian EllAbstract: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.
Hironori Yamamoto - One of the best experts on this subject based on the ideXlab platform.
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a case of successful enteroscopic balloon dilation for late anastomotic stricture of choledochojejunostomy after living donor liver transplantation
Liver Transplantation, 2005Co-Authors: Hidenori Haruta, Hironori Yamamoto, Kentaro Sugano, Koichi Mizuta, Y Kita, Takeji Uno, Satoshi Egami, Shuji Hishikawa, Hideo KawarasakiAbstract:Biliary complications remain a major concern after living donor liver transplantation. We describe a pediatric case who underwent a successful endoscopic balloon dilatation of biliary-enteric stricture following living donor liver transplantation using a newly developed method of Enteroscopy. The 7-year-old boy with late biliary stricture of choledochojejunostomy was admitted 6 years after transplantation. Since percutaneous transhepatic cholangiography was technically difficult in this case, endoscopic retrograde cholangiography was performed using a double-balloon enteroscope under general anesthesia. The enteroscope was advanced retrograde through the duodenum, jejunum, and the leg of Roux-Y by the double-balloon method, and anastomotic stricture of choledochojejunostomy was clearly confirmed by endoscopic retrograde cholangiography and endoscopic direct vision. Balloon dilatation was performed and the anastomosis was expanded. Restenosis was not noted as of 2 years after the treatment. In conclusion, endoscopic balloon dilation of biliary-enteric anastomotic stricture using a new enteroscopic method can be regarded as an alternative choice to percutaneous transhepatic management and surgical re-anatomists.
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a case of successful enteroscopic balloon dilation for late anastomotic stricture of choledochojejunostomy after living donor liver transplantation
Liver Transplantation, 2005Co-Authors: Hidenori Haruta, Hironori Yamamoto, Kentaro Sugano, Koichi Mizuta, Y Kita, Satoshi Egami, Shuji Hishikawa, Hideo KawarasakiAbstract:Biliary complications remain a major concern after living donor liver transplantation. We describe a pediatric case who underwent a successful endoscopic balloon dilatation of biliary-enteric stricture following living donor liver transplantation using a newly developed method of Enteroscopy. The 7-year-old boy with late biliary stricture of choledochojejunostomy was admitted 6 years after transplantation. Since percutaneous transhepatic cholangiography was technically difficult in this case, endoscopic retrograde cholangiography was performed using a double-balloon enteroscope under general anesthesia. The enteroscope was advanced retrograde through the duodenum, jejunum, and the leg of Roux-Y by the double-balloon method, and anastomotic stricture of choledochojejunostomy was clearly confirmed by endoscopic retrograde cholangiography and endoscopic direct vision. Balloon dilatation was performed and the anastomosis was expanded. Restenosis was not noted as of 2 years after the treatment. In conclusion, endoscopic balloon dilation of biliary-enteric anastomotic stricture using a new enteroscopic method can be regarded as an alternative choice to percutaneous transhepatic management and surgical re-anatomists. (Liver Transpl 2005;11:1608–1610.)
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clinical outcomes of Enteroscopy using the double balloon method for strictures of the small intestine
World Journal of Gastroenterology, 2005Co-Authors: Keijiro Sunada, Hironori Yamamoto, Yutaka Sekine, Tomohiko Miyata, Hiroto Kita, Tomonori Yano, Akiko Kuno, Hiroyuki Sato, Yoshikazu Hayashi, Michiko IwamotoAbstract:AIM: To evaluate the clinical outcome of Enteroscopy, using the double-balloon method, focusing on the involvement of neoplasms in strictures of the small intestine. METHODS: Enteroscopy, using the double-balloon method, was performed between December 1999 and December 2002 at Jichi Medical School Hospital, Japan and strictures of the small intestine were found in 17 out of 62 patients. These 17 consecutive patients were subjected to analysis. RESULTS: The double-balloon Enteroscopy contributed to the diagnosis of small intestinal neoplasms found in 3 out of 17 patients by direct observation of the strictures as well as biopsy sampling. Surgical procedures were chosen for these three patients, while balloon dilation was chosen for the strictures in four patients diagnosed with inflammation without involvement of neoplasm. CONCLUSION: Double-balloon Enteroscopy is a useful method for the diagnosis and treatment of strictures in the small bowel.
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Gastrointestinal stromal tumor in the jejunum: diagnosis and control of bleeding with electrocoagulation by using double-balloon Enteroscopy.
Journal of Gastroenterology, 2004Co-Authors: Makoto Nishimura, Hironori Yamamoto, Yutaka Sekine, Tomohiko Miyata, Satoru Iino, Hiroto Kita, Tomonori Yano, Keijiro Sunada, Takeshi Sugimoto, Michiko IwamotoAbstract:A 43-year-old man presented with gastrointestinal bleeding. A tumor with central ulceration was observed in the jejunum, with the use of a new Enteroscopy system called “double-balloon Enteroscopy”. Bleeding after biopsy sampling of the tumor was controlled endoscopically by using electrocoagulation. Histological findings of the biopsy specimens were consistent with gastrointestinal stromal tumor, and this was surgically resected. Double-balloon Enteroscopy was useful for the diagnosis as well as the control of bleeding in this patient.
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successful treatment with balloon dilatation using a double balloon enteroscope for a stricture in the small bowel of a patient with crohn s disease
Digestive Endoscopy, 2004Co-Authors: Keijiro Sunada, Hironori Yamamoto, Yutaka Sekine, Tomohiko Miyata, Hiroto Kita, Tomonori Yano, Akiko Kuno, Nobuki Onishi, Michiko Iwamoto, Atsuhiro SasakiAbstract:The requirement for endoscopic access to a stricture is a major limitation of the endoscopic dilatation for the treatment of strictures in the gastrointestinal tract. We have developed the double-balloon Enteroscopy method that enables visualization of the entire small bowel. In addition, double-balloon Enteroscopy has a potential for the interventional therapy including dilatation of strictures. We present here a case of jejunal strictures in a 47-year-old woman with Crohn's disease successfully treated with a balloon catheter in combination with double-balloon Enteroscopy. Balloon dilation with double-balloon Enteroscopy is a promising method for the treatment of small bowel strictures in Crohn's disease.
Hideo Kawarasaki - One of the best experts on this subject based on the ideXlab platform.
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a case of successful enteroscopic balloon dilation for late anastomotic stricture of choledochojejunostomy after living donor liver transplantation
Liver Transplantation, 2005Co-Authors: Hidenori Haruta, Hironori Yamamoto, Kentaro Sugano, Koichi Mizuta, Y Kita, Takeji Uno, Satoshi Egami, Shuji Hishikawa, Hideo KawarasakiAbstract:Biliary complications remain a major concern after living donor liver transplantation. We describe a pediatric case who underwent a successful endoscopic balloon dilatation of biliary-enteric stricture following living donor liver transplantation using a newly developed method of Enteroscopy. The 7-year-old boy with late biliary stricture of choledochojejunostomy was admitted 6 years after transplantation. Since percutaneous transhepatic cholangiography was technically difficult in this case, endoscopic retrograde cholangiography was performed using a double-balloon enteroscope under general anesthesia. The enteroscope was advanced retrograde through the duodenum, jejunum, and the leg of Roux-Y by the double-balloon method, and anastomotic stricture of choledochojejunostomy was clearly confirmed by endoscopic retrograde cholangiography and endoscopic direct vision. Balloon dilatation was performed and the anastomosis was expanded. Restenosis was not noted as of 2 years after the treatment. In conclusion, endoscopic balloon dilation of biliary-enteric anastomotic stricture using a new enteroscopic method can be regarded as an alternative choice to percutaneous transhepatic management and surgical re-anatomists.
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a case of successful enteroscopic balloon dilation for late anastomotic stricture of choledochojejunostomy after living donor liver transplantation
Liver Transplantation, 2005Co-Authors: Hidenori Haruta, Hironori Yamamoto, Kentaro Sugano, Koichi Mizuta, Y Kita, Satoshi Egami, Shuji Hishikawa, Hideo KawarasakiAbstract:Biliary complications remain a major concern after living donor liver transplantation. We describe a pediatric case who underwent a successful endoscopic balloon dilatation of biliary-enteric stricture following living donor liver transplantation using a newly developed method of Enteroscopy. The 7-year-old boy with late biliary stricture of choledochojejunostomy was admitted 6 years after transplantation. Since percutaneous transhepatic cholangiography was technically difficult in this case, endoscopic retrograde cholangiography was performed using a double-balloon enteroscope under general anesthesia. The enteroscope was advanced retrograde through the duodenum, jejunum, and the leg of Roux-Y by the double-balloon method, and anastomotic stricture of choledochojejunostomy was clearly confirmed by endoscopic retrograde cholangiography and endoscopic direct vision. Balloon dilatation was performed and the anastomosis was expanded. Restenosis was not noted as of 2 years after the treatment. In conclusion, endoscopic balloon dilation of biliary-enteric anastomotic stricture using a new enteroscopic method can be regarded as an alternative choice to percutaneous transhepatic management and surgical re-anatomists. (Liver Transpl 2005;11:1608–1610.)