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Tyler M. Berzin - One of the best experts on this subject based on the ideXlab platform.

  • Ameta-analysis on efficacy and safety: Single-Balloon vs. double-Balloon Enteroscopy
    2016
    Co-Authors: Vaibhav Wadhwa, Ram Chuttani, Douglas K Pleskow, Tyler M. Berzin, Saurabh Sethi, Sumeet Tewani, Sushil Kumar Garg, Nidhi Sethi, Mandeep S Sawhney
    Abstract:

    Background and aim: Double-Balloon Enteroscopy (DBE) and Single-Balloon Enteroscopy (SBE) are new techniques capable of providing deep Enteroscopy. Results of individual studies comparing these techniques have not been able to identify a superior strategy. Our aim was to systematically pool all available studies to compare the efficacy and safety of DBE with SBE for evaluation of the small bowel. Methods: Databases were searched, including PubMed, Embase, and the Cochrane Central Register of Controlled Trials. The main outcome measures were complete small-bowel visualization, diagnostic yield, therapeutic yield, and complication rate. Statistical analysis was performed using Review Manager (RevMan version 5.2). Meta-analysis was performed using fixed-effect or random-effect methods, depending on the absence or presence of significant heterogeneity. We used the v2 and I2 test to assess heterogeneity between trials. Results were expressed as risk ratios (RR) or mean differences with 95% confidence intervals (CI). Results: Four prospective, randomized, controlled trials with a total of 375 patients were identified. DBE was superior to SBE for vi-sualization of the entire small bowel [pooled RR0.37 (95 % CI: 0.19–0.73; P0.004)]. DBE and SBE were similar in ability to provide diagnosis [pooled RR0.95 (95 % CI: 0.77–1.17; P0.62)]. There was no significant difference between DBE and SBE in therapeuti

  • systematic review and meta analysis of Single Balloon Enteroscopy assisted ercp in patients with surgically altered gi anatomy
    Gastrointestinal Endoscopy, 2015
    Co-Authors: Sumant Inamdar, Douglas K Pleskow, Tyler M. Berzin, Eoin Slattery, Divyesh V Sejpal, Larry S Miller, Arvind J Trindade
    Abstract:

    Background Surgically altered pancreaticobiliary anatomy increases the difficulty of performing ERCP. Single-Balloon Enteroscopy (SBE) is a relatively new technique that can be used for ERCP in patients with surgically altered anatomy. Objective To evaluate the therapeutic and diagnostic success of SBE-ERCP among patients with surgically altered anatomy. Design/Setting Systematic review and meta-analysis of studies involving SBE-ERCP in patients with Roux-en-Y gastric bypass, hepaticojejunostomy, or Whipple procedure. Enteroscopy success was defined as success in reaching the papilla and/or biliary anastomosis by using SBE. Diagnostic success was defined as obtaining a cholangiogram. Procedural success was defined as the ability to provide successful intervention, if appropriate. A random-effects model was used. Results A total of 461 patients underwent SBE-ERCP from 15 trials. The pooled Enteroscopy, diagnostic, and procedural success rates were 80.9% (95% confidence interval [CI], 75.3%-86.4%), 69.4% (95% CI, 61.0%-77.9%), and 61.7% (95% CI, 52.9%-70.5%), respectively. There was statistical large heterogeneity for Enteroscopy, diagnostic, and therapeutic success ( P Limitations Our findings and interpretations are limited by the quantity and heterogeneity of the studies included in the analysis. Conclusion SBE-ERCP has high diagnostic and procedural success rates in this challenging patient population. It should be considered a first-line intervention when biliary access is required after Roux-en-Y gastric bypass, hepaticojejunostomy, or Whipple procedure.

  • a meta analysis on efficacy and safety Single Balloon vs double Balloon Enteroscopy
    Gastroenterology Report, 2015
    Co-Authors: Vaibhav Wadhwa, Ram Chuttani, Douglas K Pleskow, Tyler M. Berzin, Saurabh Sethi, Sumeet Tewani, Sushil Kumar Garg, Nidhi Sethi, Mandeep S Sawhney
    Abstract:

    Background and aim: Double-Balloon Enteroscopy (DBE) and Single-Balloon Enteroscopy (SBE) are new techniques capable of providing deep Enteroscopy. Results of individual studies comparing these techniques have not been able to identify a superior strategy. Our aim was to systematically pool all available studies to compare the efficacy and safety of DBE with SBE for evaluation of the small bowel. Methods: Databases were searched, including PubMed, Embase, and the Cochrane Central Register of Controlled Trials. The main outcome measures were complete small-bowel visualization, diagnostic yield, therapeutic yield, and complication rate. Statistical analysis was performed using Review Manager (RevMan version 5.2). Meta-analysis was performed using fixed-effect or random-effect methods, depending on the absence or presence of significant heterogeneity. We used the v 2 and I 2 test to assess heterogeneity between trials. Results were expressed as risk ratios (RR) or mean differences with 95% confidence intervals (CI). Results: Four prospective, randomized, controlled trials with a total of 375 patients were identified. DBE was superior to SBE for visualization of the entire small bowel [pooled RR ¼ 0.37 (95% CI: 0.19‐0.73; P ¼ 0.004)]. DBE and SBE were similar in ability to provide diagnosis [pooled RR ¼ 0.95 (95% CI: 0.77‐1.17; P ¼ 0.62)]. There was no significant difference between DBE and SBE in therapeutic yield [pooled RR ¼ 0.78 (95% CI: 0.59‐1.04; P ¼ 0.09)] and complication rate [pooled RR ¼ 1.08 (95% CI: 0.28‐4.22); P ¼ 0.91]. Conclusions: DBE was superior to SBE with regard to complete small bowel visualization. DBE was similar to SBE with regard to diagnostic yield, ability to provide treatment and complication rate, but these results should be interpreted with caution as they is based on very few studies and the overall quality of the evidence was rated as low to moderate, due to the small sample size.

  • use of a cap in Single Balloon Enteroscopy assisted endoscopic retrograde cholangiography
    Endoscopy, 2014
    Co-Authors: Arvind J Trindade, Jonah Cohen, Sagar Garud, Mandeep S Sawhney, Ram Chuttani, Douglas K Pleskow, Eoin Slattery, Jose M Mella, Jacob Dickstein, Tyler M. Berzin
    Abstract:

    Background and study aim: Cannulation of the native papilla in surgically altered anatomy is difficult in endoscopic retrograde cholangiography (ERC). There are limited data regarding the success of Single-Balloon Enteroscopy-assisted ERC (SBE-ERC) in patients with a native papilla and Roux-en-Y gastric bypass. Use of a plastic cap may assist cannulation in these cases. The aim of the current study was to investigate the use of SBE-ERC with a cap (Cap-SBE-ERC) in patients with surgically altered anatomy referred for ERC. Patients and methods: Patients with surgically altered anatomy (hepaticojejunostomy, gastric bypass surgery, and Whipple’s surgery) who underwent Cap-SBE-ERC were identified from a prospectively maintained database. Outcomes were diagnostic and procedural success. Patients with a native papilla were compared with those with a biliary-enteric anastomosis. Results: Among 56 patients with surgically altered anatomy, high rates of diagnostic and procedural success were observed (78.6 % and 71.4 %, respectively). High diagnostic and procedural success rates of 72.7 % and 65.9 %, respectively, were also observed for patients with Roux-en-Y gastric bypass anatomy with a native papilla (n = 44). Conclusion: High rates of diagnostic and procedural success were reported for SBE-ERC with the use of a cap, including a large subgroup of patients with Roux-en-Y gastric bypass and a native papilla.

  • prior capsule endoscopy improves the diagnostic and therapeutic yield of Single Balloon Enteroscopy
    Digestive Diseases and Sciences, 2014
    Co-Authors: Saurabh Sethi, Jonah Cohen, Sagar Garud, Mandeep S Sawhney, Ram Chuttani, Douglas K Pleskow, Adarsh M Thaker, Kenneth R Falchuk, Tyler M. Berzin
    Abstract:

    Although there is substantial literature addressing double-Balloon Enteroscopy, evidence is more limited with regard to the clinical utility of Single-Balloon Enteroscopy (SBE) in evaluating and treating small-bowel diseases. We sought to determine the diagnostic and therapeutic yield of SBE in patients with suspected small-bowel disorders, as well as the impact of preceding capsule endoscopy (CE) on these outcomes. We performed a retrospective analysis of a prospectively collected database at a tertiary-care academic medical center between 2011 and 2013 for all patients referred for SBE. A total of 150 patients underwent 170 SBE procedures during the study period. The most frequent indications for SBE included anemia, overt or occult gastrointestinal bleeding, and suspected mass. CE was performed prior to SBE in 113 of 150 patients (75 %). The overall diagnostic yield for small-bowel disease by CE was 62 %. Therapeutic interventions included hemostasis, polypectomy, and foreign body removal. Total diagnostic and therapeutic yield of SBE was 60 and 28 %, respectively. The diagnostic yield of SBE with prior CE was 68 versus 44 % for SBE without prior CE (P = 0.002). The therapeutic yield of SBE with prior CE was 35 versus 12 % without prior CE (P = 0.001). One endoscopic complication was observed out of 170 procedures, and there were no deaths. SBE appears to be a safe and effective technique for the diagnosis and treatment of small-bowel disease; however, we recommend performing a CE prior to SBE to improve the diagnostic and therapeutic yield of the procedure.

Peter Mensink - One of the best experts on this subject based on the ideXlab platform.

  • hyperamylasemia and pancreatitis following spiral Enteroscopy
    Canadian Journal of Gastroenterology & Hepatology, 2012
    Co-Authors: Christopher W Teshima, Ernst J Kuipers, Huseyin Aktas, Peter Mensink
    Abstract:

    BACKGROUND: Acute pancreatitis is a significant potential complication with double-Balloon Enteroscopy. Hyperamylasemia is frequently observed after both double-Balloon Enteroscopy and Single-Balloon Enteroscopy but often without associated pancreatitis. Whether the same phenomenon occurs with spiral Enteroscopy is currently unknown.

  • Single Balloon Enteroscopy assisted direct percutaneous endoscopic jejunostomy
    Endoscopy, 2012
    Co-Authors: Huseyin Aktas, Peter Mensink, E J Kuipers, H R Van Buuren
    Abstract:

    Direct percutaneous endoscopic jejunostomy (DPEJ) has emerged as a viable alternative for percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) in patients who cannot tolerate gastric feeding. Reportedly, DPEJ placement with regular endoscopes fails in up to one-third of cases. The aim of the current study was to assess the efficacy and safety of Single-Balloon Enteroscopy (SBE)-assisted DPEJ. The DPEJ placement technique was comparable to conventional PEG placement. A total of 12 DPEJ procedures were performed in 11 patients (mean age 55 years [range 24 – 83 years]; seven males). SBE-assisted DPEJ was successful in 11 of the 12 procedures (92 %). Post-procedural complications included gastroparesis and aspiration pneumonia in one case each. We conclude that SBE-assisted DPEJ placement seems a safe and successful approach for patients requiring jejunal enteral feeding.

  • Single Balloon Enteroscopy magnetic resonance enterography and abdominal us useful for evaluation of small bowel disease in children with suspected crohn s disease
    Gastrointestinal Endoscopy, 2012
    Co-Authors: Lissy De Ridder, Peter Mensink, Huseyin Aktas, Maarten H Lequin, Ronald R De Krijger, Janneke C Van Der Woude, Johanna C Escher
    Abstract:

    Background The usefulness of Single-Balloon Enteroscopy (SBE) has not been evaluated in children with known or suspected Crohn's disease (CD). Objective The objectives of this study are to evaluate the diagnostic yield of SBE for pediatric CD by comparing it with US and magnetic resonance enterography (MRE). Design Single-center prospective study. Setting Tertiary-care referral hospital. Patients Between February 2009 and April 2010, 20 pediatric patients (ages 8-18 years) with suspected inflammatory bowel disease (IBD) or with a previous diagnosis of CD with suspected persistent small-bowel disease were enrolled. Interventions All patients underwent proximal and distal SBE, 17 patients also underwent US combined with Doppler flow measurements, and 18 underwent MRE. Main Outcome Measurements The findings of US with Doppler flow measurements and MRE were compared with those with SBE. Results The mean patient age was 15.0 years (range 11.3-18 years, 70% male). Of 14 patients with suspected IBD, 8 had a diagnosis of CD made after SBE. Activity in the small bowel was found in 14 patients (70%) with both suspected and previously diagnosed CD. Twelve patients (60%) had small-bowel disease that was out of reach of conventional endoscopy. Three patients (15%) had small-bowel activity solely in the jejunum, which was not detected by either MRE or US. Limitations Single-center study with small sample size. Conclusions SBE can be used in children to accurately assess small-bowel disease and CD. Small-bowel activity may be identified by SBE in some patients in whom it may not be apparent despite use of conventional upper endoscopy, ileocolonoscopy, US with Doppler flow measurements, or MRE.

  • Single vs double Balloon Enteroscopy in small bowel diagnostics a randomized multicenter trial
    Endoscopy, 2011
    Co-Authors: Dirk Domagk, Philipp Lenz, Peter Mensink, Huseyin Aktas, T Meister, Andreas Luegering, H Ullerich, Lars Aabakken, Achim Heinecke, W Domschke
    Abstract:

    BACKGROUND AND STUDY AIMS: Double-Balloon Enteroscopy (DBE) is the first choice endoscopic technique for small-bowel visualization. However, preparation and handling of the double-Balloon enteroscope is complex. Recently, a Single-Balloon Enteroscopy (SBE) system has been introduced as being a simplified, less-complex Balloon-assisted Enteroscopy system. PATIENTS AND METHODS: This study was a randomized international multicenter trial comparing two Balloon-assisted Enteroscopy systems: DBE vs. SBE. Consecutive patients referred for Balloon-assisted Enteroscopy were randomized to either DBE or SBE. Patients were blinded with regard to the type of instrument used. The primary study outcome was oral insertion depth. Secondary outcomes included complete small-bowel visualization, anal insertion depth, patient discomfort, and adverse events. Patient discomfort during and after the procedure was scored using a visual analog scale. RESULTS: A total of 130 patients were included over 12 months: 65 with DBE and 65 with the SBE technique. Patient and procedure characteristics were comparable between the two groups. Mean oral intubation depth was 253 cm with DBE and 258 cm with SBE, showing noninferiority of SBE vs. DBE. Complete visualization of the small bowel was achieved in 18 % and 11 % of procedures in the DBE and SBE groups, respectively. Mean anal intubation depth was 107 cm in the DBE group and 118 cm in the SBE group. Diagnostic yield and mean pain scores during and after the procedures were similar in the two groups. No adverse events were observed during or after the examinations. CONCLUSIONS: This head-to-head comparison study shows that DBE and SBE have a comparable performance and diagnostic yield for evaluation of the small bowel.

  • complications of Single Balloon Enteroscopy a prospective evaluation of 166 procedures
    Endoscopy, 2010
    Co-Authors: Huseyin Aktas, Jelle Haringsma, L De Ridder, E J Kuipers, Peter Mensink
    Abstract:

    Background and study aim: Double-Balloon Enteroscopy (DBE) has proven to be a relatively safe method for small-bowel evaluation, with a complication rate of 1%. The main concern after diagnostic DBE is acute pancreatitis. Single-Balloon Enteroscopy (SBE) has emerged as a viable alternative to DBE. Until now, no incidence of pancreatitis has been reported for SBE. The aims were to evaluate complication rate and occurrence of hyperamylasemia and to identify the risk factors for hyperamylasemia after SBE. Patients and methods: Prospectively, consecutive patients undergoing peroral ("proximal") or combined approach SBE were included. Complications were assessed at 1 and 30 days afterwards. Serum amylase and C-reactive protein (CRP) were assessed immediately before and 23 hours after SBE. Results: 166 SBE procedures were performed in 105 patients (53-male; mean age 51 years, range 9-87). The indications for SBE were: anemia (n = 55), Crohn's disease (n = 31) and abdominal complaints suspicious for inflammatory bowel disease (n = 5), Peutz-Jeghers syndrome (n = 1) and other (n = 13). Therapeutic interventions were performed during 21 procedures (13 %). One perforation (1/21 therapeutic interventions, 4.8 %) occurred after dilation of a benign stricture. While 13 patients (16 %) had post-SBE hyperamylasemia, none had complaints suggesting acute pancreatitis. Factors such as sex, indication, procedure duration, number of passes, route of SBE, findings, and/or treatment showed no significant correlation with presence of hyperamylasemia. Conclusions: SBE appears to be a safe diagnostic endoscopic procedure. The incidence of hyperamylasemia and pancreatitis after peroral SBE seems comparable to that after DBE.

Huseyin Aktas - One of the best experts on this subject based on the ideXlab platform.

  • hyperamylasemia and pancreatitis following spiral Enteroscopy
    Canadian Journal of Gastroenterology & Hepatology, 2012
    Co-Authors: Christopher W Teshima, Ernst J Kuipers, Huseyin Aktas, Peter Mensink
    Abstract:

    BACKGROUND: Acute pancreatitis is a significant potential complication with double-Balloon Enteroscopy. Hyperamylasemia is frequently observed after both double-Balloon Enteroscopy and Single-Balloon Enteroscopy but often without associated pancreatitis. Whether the same phenomenon occurs with spiral Enteroscopy is currently unknown.

  • Single Balloon Enteroscopy assisted direct percutaneous endoscopic jejunostomy
    Endoscopy, 2012
    Co-Authors: Huseyin Aktas, Peter Mensink, E J Kuipers, H R Van Buuren
    Abstract:

    Direct percutaneous endoscopic jejunostomy (DPEJ) has emerged as a viable alternative for percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) in patients who cannot tolerate gastric feeding. Reportedly, DPEJ placement with regular endoscopes fails in up to one-third of cases. The aim of the current study was to assess the efficacy and safety of Single-Balloon Enteroscopy (SBE)-assisted DPEJ. The DPEJ placement technique was comparable to conventional PEG placement. A total of 12 DPEJ procedures were performed in 11 patients (mean age 55 years [range 24 – 83 years]; seven males). SBE-assisted DPEJ was successful in 11 of the 12 procedures (92 %). Post-procedural complications included gastroparesis and aspiration pneumonia in one case each. We conclude that SBE-assisted DPEJ placement seems a safe and successful approach for patients requiring jejunal enteral feeding.

  • Single Balloon Enteroscopy magnetic resonance enterography and abdominal us useful for evaluation of small bowel disease in children with suspected crohn s disease
    Gastrointestinal Endoscopy, 2012
    Co-Authors: Lissy De Ridder, Peter Mensink, Huseyin Aktas, Maarten H Lequin, Ronald R De Krijger, Janneke C Van Der Woude, Johanna C Escher
    Abstract:

    Background The usefulness of Single-Balloon Enteroscopy (SBE) has not been evaluated in children with known or suspected Crohn's disease (CD). Objective The objectives of this study are to evaluate the diagnostic yield of SBE for pediatric CD by comparing it with US and magnetic resonance enterography (MRE). Design Single-center prospective study. Setting Tertiary-care referral hospital. Patients Between February 2009 and April 2010, 20 pediatric patients (ages 8-18 years) with suspected inflammatory bowel disease (IBD) or with a previous diagnosis of CD with suspected persistent small-bowel disease were enrolled. Interventions All patients underwent proximal and distal SBE, 17 patients also underwent US combined with Doppler flow measurements, and 18 underwent MRE. Main Outcome Measurements The findings of US with Doppler flow measurements and MRE were compared with those with SBE. Results The mean patient age was 15.0 years (range 11.3-18 years, 70% male). Of 14 patients with suspected IBD, 8 had a diagnosis of CD made after SBE. Activity in the small bowel was found in 14 patients (70%) with both suspected and previously diagnosed CD. Twelve patients (60%) had small-bowel disease that was out of reach of conventional endoscopy. Three patients (15%) had small-bowel activity solely in the jejunum, which was not detected by either MRE or US. Limitations Single-center study with small sample size. Conclusions SBE can be used in children to accurately assess small-bowel disease and CD. Small-bowel activity may be identified by SBE in some patients in whom it may not be apparent despite use of conventional upper endoscopy, ileocolonoscopy, US with Doppler flow measurements, or MRE.

  • Single vs double Balloon Enteroscopy in small bowel diagnostics a randomized multicenter trial
    Endoscopy, 2011
    Co-Authors: Dirk Domagk, Philipp Lenz, Peter Mensink, Huseyin Aktas, T Meister, Andreas Luegering, H Ullerich, Lars Aabakken, Achim Heinecke, W Domschke
    Abstract:

    BACKGROUND AND STUDY AIMS: Double-Balloon Enteroscopy (DBE) is the first choice endoscopic technique for small-bowel visualization. However, preparation and handling of the double-Balloon enteroscope is complex. Recently, a Single-Balloon Enteroscopy (SBE) system has been introduced as being a simplified, less-complex Balloon-assisted Enteroscopy system. PATIENTS AND METHODS: This study was a randomized international multicenter trial comparing two Balloon-assisted Enteroscopy systems: DBE vs. SBE. Consecutive patients referred for Balloon-assisted Enteroscopy were randomized to either DBE or SBE. Patients were blinded with regard to the type of instrument used. The primary study outcome was oral insertion depth. Secondary outcomes included complete small-bowel visualization, anal insertion depth, patient discomfort, and adverse events. Patient discomfort during and after the procedure was scored using a visual analog scale. RESULTS: A total of 130 patients were included over 12 months: 65 with DBE and 65 with the SBE technique. Patient and procedure characteristics were comparable between the two groups. Mean oral intubation depth was 253 cm with DBE and 258 cm with SBE, showing noninferiority of SBE vs. DBE. Complete visualization of the small bowel was achieved in 18 % and 11 % of procedures in the DBE and SBE groups, respectively. Mean anal intubation depth was 107 cm in the DBE group and 118 cm in the SBE group. Diagnostic yield and mean pain scores during and after the procedures were similar in the two groups. No adverse events were observed during or after the examinations. CONCLUSIONS: This head-to-head comparison study shows that DBE and SBE have a comparable performance and diagnostic yield for evaluation of the small bowel.

  • complications of Single Balloon Enteroscopy a prospective evaluation of 166 procedures
    Endoscopy, 2010
    Co-Authors: Huseyin Aktas, Jelle Haringsma, L De Ridder, E J Kuipers, Peter Mensink
    Abstract:

    Background and study aim: Double-Balloon Enteroscopy (DBE) has proven to be a relatively safe method for small-bowel evaluation, with a complication rate of 1%. The main concern after diagnostic DBE is acute pancreatitis. Single-Balloon Enteroscopy (SBE) has emerged as a viable alternative to DBE. Until now, no incidence of pancreatitis has been reported for SBE. The aims were to evaluate complication rate and occurrence of hyperamylasemia and to identify the risk factors for hyperamylasemia after SBE. Patients and methods: Prospectively, consecutive patients undergoing peroral ("proximal") or combined approach SBE were included. Complications were assessed at 1 and 30 days afterwards. Serum amylase and C-reactive protein (CRP) were assessed immediately before and 23 hours after SBE. Results: 166 SBE procedures were performed in 105 patients (53-male; mean age 51 years, range 9-87). The indications for SBE were: anemia (n = 55), Crohn's disease (n = 31) and abdominal complaints suspicious for inflammatory bowel disease (n = 5), Peutz-Jeghers syndrome (n = 1) and other (n = 13). Therapeutic interventions were performed during 21 procedures (13 %). One perforation (1/21 therapeutic interventions, 4.8 %) occurred after dilation of a benign stricture. While 13 patients (16 %) had post-SBE hyperamylasemia, none had complaints suggesting acute pancreatitis. Factors such as sex, indication, procedure duration, number of passes, route of SBE, findings, and/or treatment showed no significant correlation with presence of hyperamylasemia. Conclusions: SBE appears to be a safe diagnostic endoscopic procedure. The incidence of hyperamylasemia and pancreatitis after peroral SBE seems comparable to that after DBE.

Tomoyuki Tsujikawa - One of the best experts on this subject based on the ideXlab platform.

  • Magnified Single-Balloon Enteroscopy in the diagnosis of intestinal follicular lymphoma: a case series
    Korean Association for the Study of Intestinal Diseases, 2018
    Co-Authors: Kenichiro Takahashi, Tomoyuki Tsujikawa, Atsushi Nishida, Mitsushige Sugimoto, Osamu Inatomi, Shigeki Bamba, Ryoji Kushima, Masahiro Kawahara, Masaya Sasaki, Katsuyuki Kitoh
    Abstract:

    The objective of this study was to evaluate the magnified endoscopic findings in the diagnosis of follicular lymphoma in the small intestine in comparison with those of intestinal follicular lymphoma and lymphangiectasia. Four patients with follicular lymphoma and 3 with lymphangiectasia in the small intestine were retrospectively analyzed. A prototype magnifying SingleBalloon enteroscope was used. The findings of the intestinal follicular lymphoma and lymphangiectasia were retrospectively analyzed to determine the magnified endoscopic findings of follicular lymphoma in the small intestine. Opaque white granules were observed in 3 of the 4 patients with follicular lymphoma. Magnified narrow-band imaging (NBI) of the opaque white granules showed stretched microvessels, which had a diminutive tree-like appearance. The remaining patient had no opaque white granules and only displayed whitish villi. Magnified NBI observation of the whitish villi revealed the absence of marginal villus epithelium, which was confirmed by histology. The magnified NBI Enteroscopy revealed the diminutive tree-like appearance on the opaque white granules and the absence of marginal villus epithelium of the whitish villi in intestinal follicular lymphoma. These findings may be useful in diagnosing follicular lymphoma

  • application of novel magnified Single Balloon Enteroscopy for a patient with cronkhite canada syndrome
    World Journal of Gastroenterology, 2017
    Co-Authors: Masaki Murata, Hirotsugu Imaeda, Kenichiro Takahashi, Tomoyuki Tsujikawa, Atsushi Nishida, Mitsushige Sugimoto, Osamu Inatomi, Shigeki Bamba, Ryoji Kushima, Akira Andoh
    Abstract:

    Application of novel magnified Single Balloon Enteroscopy for a patient with Cronkhite-Canada syndrome

  • factors affecting pancreatic hyperamylasemia in patients undergoing peroral Single Balloon Enteroscopy
    Digestive Endoscopy, 2015
    Co-Authors: Tomoyuki Tsujikawa, Hirotsugu Imaeda, Atsushi Nishida, Osamu Inatomi, Shigeki Bamba, Hiroshi Hasegawa, Hiromitsu Ban, Akihiko Itoh, Takao Saotome, Masaya Sasaki
    Abstract:

    Background and Aim Acute pancreatitis following Balloon-assisted Enteroscopy is a rare but serious complication. The causative mechanism is uncertain and prevention strategies are not established. We conducted a retrospective study to clarify the risk factors for pancreatic hyperamylasemia. Methods Eighty-four patients undergoing peroral Single-Balloon Enteroscopy (SBE) were enrolled in this study. Serum pancreatic and salivary amylase levels were measured 2 h after endoscopic examination. Results We experienced three patients with post-SBE pancreatitis. Factors predicting pancreatic hyperamylasemia were: (i) elderly patients; (ii) deeper insertion; and (iii) clockwise insertion. In contrast, younger age at examination was a significant factor observed in salivary hyperamylasemia. Conclusions It is important to measure pancreatic amylase and not total amylase after SBE. When carrying out peroral SBE, the distance of insertion should be reduced especially if the scope traces a clockwise loop or the subject is elderly.

  • novel Single Balloon Enteroscopy for diagnosis and treatment of the small intestine preliminary experiences
    Endoscopy, 2007
    Co-Authors: Tomoyuki Tsujikawa, Hirotsugu Imaeda, Akira Andoh, Yasuharu Saitoh, Kazunori Hata, Hideki Minematsu, K Senoh, Kiyoyuki Hayafuji, Atsuhiro Ogawa, Tamio Nakahara
    Abstract:

    BACKGROUND AND AIM: As a tool for examining the small intestine, double-Balloon Enteroscopy (DBE) has been used routinely. However, there remain a few issues relating to the handling of DBE, such as attaching a Balloon to the tip of the scope, and inflating/deflating the two Balloon systems. Recently, we developed a novel Single-Balloon Enteroscopy (SBE) system for the examination of the small intestine. The aim of the present study was to evaluate the insertion technique, the safety, and the clinical impact of the SBE system. PATIENTS AND METHODS: Between January 2006 and June 2007, all patients undergoing Enteroscopy with the Olympus SBE system (length 200 cm, outer diameter 9.2 mm) were studied. Instead of a Balloon attached to the distal scope end, the distal scope end was hook-shaped, and manipulating the up-angle or down-angle of the scope end enabled exploration of the small intestine. RESULTS: A total of 78 procedures were performed in 41 patients (24 men, 17 women; mean age 48.9 years, range 23 - 85 years). The indications for the examination were suspected mid-gastrointestinal bleeding (n = 12), Crohn's disease (n = 17), abdominal pain (n = 8), and abdominal tumor (n = 4). The mean procedure time was 62.8 +/- 20.2 minutes and 70.4 +/- 19.3 minutes for the oral and anal routes, respectively. Among 24 patients in whom total Enteroscopy was attempted, the entire small intestine was explored in 6. CONCLUSION: SBE is not only easy to perform, due to the Single Balloon, but it can also safely examine the deep small intestine. Therefore, SBE may be a useful diagnostic and therapeutic tool in addition to DBE for investigating suspected small bowel disease.

  • novel Single Balloon Enteroscopy for diagnosis and treatment of the small intestine preliminary experiences
    Endoscopy, 2007
    Co-Authors: Tomoyuki Tsujikawa, Hirotsugu Imaeda, Akira Andoh, Yasuharu Saitoh, Kazunori Hata, Hideki Minematsu, K Senoh, Kiyoyuki Hayafuji, Atsuhiro Ogawa, Tamio Nakahara
    Abstract:

    Background and aim As a tool for examining the small intestine, double-Balloon Enteroscopy (DBE) has been used routinely. However, there remain a few issues relating to the handling of DBE, such as attaching a Balloon to the tip of the scope, and inflating/deflating the two Balloon systems. Recently, we developed a novel Single-Balloon Enteroscopy (SBE) system for the examination of the small intestine. The aim of the present study was to evaluate the insertion technique, the safety, and the clinical impact of the SBE system. Patients and methods Between January 2006 and June 2007, all patients undergoing Enteroscopy with the Olympus SBE system (length 200 cm, outer diameter 9.2 mm) were studied. Instead of a Balloon attached to the distal scope end, the distal scope end was hook-shaped, and manipulating the up-angle or down-angle of the scope end enabled exploration of the small intestine. Results A total of 78 procedures were performed in 41 patients (24 men, 17 women; mean age 48.9 years, range 23 - 85 years). The indications for the examination were suspected mid-gastrointestinal bleeding (n = 12), Crohn's disease (n = 17), abdominal pain (n = 8), and abdominal tumor (n = 4). The mean procedure time was 62.8 +/- 20.2 minutes and 70.4 +/- 19.3 minutes for the oral and anal routes, respectively. Among 24 patients in whom total Enteroscopy was attempted, the entire small intestine was explored in 6. Conclusion SBE is not only easy to perform, due to the Single Balloon, but it can also safely examine the deep small intestine. Therefore, SBE may be a useful diagnostic and therapeutic tool in addition to DBE for investigating suspected small bowel disease.

Douglas K Pleskow - One of the best experts on this subject based on the ideXlab platform.

  • Ameta-analysis on efficacy and safety: Single-Balloon vs. double-Balloon Enteroscopy
    2016
    Co-Authors: Vaibhav Wadhwa, Ram Chuttani, Douglas K Pleskow, Tyler M. Berzin, Saurabh Sethi, Sumeet Tewani, Sushil Kumar Garg, Nidhi Sethi, Mandeep S Sawhney
    Abstract:

    Background and aim: Double-Balloon Enteroscopy (DBE) and Single-Balloon Enteroscopy (SBE) are new techniques capable of providing deep Enteroscopy. Results of individual studies comparing these techniques have not been able to identify a superior strategy. Our aim was to systematically pool all available studies to compare the efficacy and safety of DBE with SBE for evaluation of the small bowel. Methods: Databases were searched, including PubMed, Embase, and the Cochrane Central Register of Controlled Trials. The main outcome measures were complete small-bowel visualization, diagnostic yield, therapeutic yield, and complication rate. Statistical analysis was performed using Review Manager (RevMan version 5.2). Meta-analysis was performed using fixed-effect or random-effect methods, depending on the absence or presence of significant heterogeneity. We used the v2 and I2 test to assess heterogeneity between trials. Results were expressed as risk ratios (RR) or mean differences with 95% confidence intervals (CI). Results: Four prospective, randomized, controlled trials with a total of 375 patients were identified. DBE was superior to SBE for vi-sualization of the entire small bowel [pooled RR0.37 (95 % CI: 0.19–0.73; P0.004)]. DBE and SBE were similar in ability to provide diagnosis [pooled RR0.95 (95 % CI: 0.77–1.17; P0.62)]. There was no significant difference between DBE and SBE in therapeuti

  • systematic review and meta analysis of Single Balloon Enteroscopy assisted ercp in patients with surgically altered gi anatomy
    Gastrointestinal Endoscopy, 2015
    Co-Authors: Sumant Inamdar, Douglas K Pleskow, Tyler M. Berzin, Eoin Slattery, Divyesh V Sejpal, Larry S Miller, Arvind J Trindade
    Abstract:

    Background Surgically altered pancreaticobiliary anatomy increases the difficulty of performing ERCP. Single-Balloon Enteroscopy (SBE) is a relatively new technique that can be used for ERCP in patients with surgically altered anatomy. Objective To evaluate the therapeutic and diagnostic success of SBE-ERCP among patients with surgically altered anatomy. Design/Setting Systematic review and meta-analysis of studies involving SBE-ERCP in patients with Roux-en-Y gastric bypass, hepaticojejunostomy, or Whipple procedure. Enteroscopy success was defined as success in reaching the papilla and/or biliary anastomosis by using SBE. Diagnostic success was defined as obtaining a cholangiogram. Procedural success was defined as the ability to provide successful intervention, if appropriate. A random-effects model was used. Results A total of 461 patients underwent SBE-ERCP from 15 trials. The pooled Enteroscopy, diagnostic, and procedural success rates were 80.9% (95% confidence interval [CI], 75.3%-86.4%), 69.4% (95% CI, 61.0%-77.9%), and 61.7% (95% CI, 52.9%-70.5%), respectively. There was statistical large heterogeneity for Enteroscopy, diagnostic, and therapeutic success ( P Limitations Our findings and interpretations are limited by the quantity and heterogeneity of the studies included in the analysis. Conclusion SBE-ERCP has high diagnostic and procedural success rates in this challenging patient population. It should be considered a first-line intervention when biliary access is required after Roux-en-Y gastric bypass, hepaticojejunostomy, or Whipple procedure.

  • a meta analysis on efficacy and safety Single Balloon vs double Balloon Enteroscopy
    Gastroenterology Report, 2015
    Co-Authors: Vaibhav Wadhwa, Ram Chuttani, Douglas K Pleskow, Tyler M. Berzin, Saurabh Sethi, Sumeet Tewani, Sushil Kumar Garg, Nidhi Sethi, Mandeep S Sawhney
    Abstract:

    Background and aim: Double-Balloon Enteroscopy (DBE) and Single-Balloon Enteroscopy (SBE) are new techniques capable of providing deep Enteroscopy. Results of individual studies comparing these techniques have not been able to identify a superior strategy. Our aim was to systematically pool all available studies to compare the efficacy and safety of DBE with SBE for evaluation of the small bowel. Methods: Databases were searched, including PubMed, Embase, and the Cochrane Central Register of Controlled Trials. The main outcome measures were complete small-bowel visualization, diagnostic yield, therapeutic yield, and complication rate. Statistical analysis was performed using Review Manager (RevMan version 5.2). Meta-analysis was performed using fixed-effect or random-effect methods, depending on the absence or presence of significant heterogeneity. We used the v 2 and I 2 test to assess heterogeneity between trials. Results were expressed as risk ratios (RR) or mean differences with 95% confidence intervals (CI). Results: Four prospective, randomized, controlled trials with a total of 375 patients were identified. DBE was superior to SBE for visualization of the entire small bowel [pooled RR ¼ 0.37 (95% CI: 0.19‐0.73; P ¼ 0.004)]. DBE and SBE were similar in ability to provide diagnosis [pooled RR ¼ 0.95 (95% CI: 0.77‐1.17; P ¼ 0.62)]. There was no significant difference between DBE and SBE in therapeutic yield [pooled RR ¼ 0.78 (95% CI: 0.59‐1.04; P ¼ 0.09)] and complication rate [pooled RR ¼ 1.08 (95% CI: 0.28‐4.22); P ¼ 0.91]. Conclusions: DBE was superior to SBE with regard to complete small bowel visualization. DBE was similar to SBE with regard to diagnostic yield, ability to provide treatment and complication rate, but these results should be interpreted with caution as they is based on very few studies and the overall quality of the evidence was rated as low to moderate, due to the small sample size.

  • use of a cap in Single Balloon Enteroscopy assisted endoscopic retrograde cholangiography
    Endoscopy, 2014
    Co-Authors: Arvind J Trindade, Jonah Cohen, Sagar Garud, Mandeep S Sawhney, Ram Chuttani, Douglas K Pleskow, Eoin Slattery, Jose M Mella, Jacob Dickstein, Tyler M. Berzin
    Abstract:

    Background and study aim: Cannulation of the native papilla in surgically altered anatomy is difficult in endoscopic retrograde cholangiography (ERC). There are limited data regarding the success of Single-Balloon Enteroscopy-assisted ERC (SBE-ERC) in patients with a native papilla and Roux-en-Y gastric bypass. Use of a plastic cap may assist cannulation in these cases. The aim of the current study was to investigate the use of SBE-ERC with a cap (Cap-SBE-ERC) in patients with surgically altered anatomy referred for ERC. Patients and methods: Patients with surgically altered anatomy (hepaticojejunostomy, gastric bypass surgery, and Whipple’s surgery) who underwent Cap-SBE-ERC were identified from a prospectively maintained database. Outcomes were diagnostic and procedural success. Patients with a native papilla were compared with those with a biliary-enteric anastomosis. Results: Among 56 patients with surgically altered anatomy, high rates of diagnostic and procedural success were observed (78.6 % and 71.4 %, respectively). High diagnostic and procedural success rates of 72.7 % and 65.9 %, respectively, were also observed for patients with Roux-en-Y gastric bypass anatomy with a native papilla (n = 44). Conclusion: High rates of diagnostic and procedural success were reported for SBE-ERC with the use of a cap, including a large subgroup of patients with Roux-en-Y gastric bypass and a native papilla.

  • prior capsule endoscopy improves the diagnostic and therapeutic yield of Single Balloon Enteroscopy
    Digestive Diseases and Sciences, 2014
    Co-Authors: Saurabh Sethi, Jonah Cohen, Sagar Garud, Mandeep S Sawhney, Ram Chuttani, Douglas K Pleskow, Adarsh M Thaker, Kenneth R Falchuk, Tyler M. Berzin
    Abstract:

    Although there is substantial literature addressing double-Balloon Enteroscopy, evidence is more limited with regard to the clinical utility of Single-Balloon Enteroscopy (SBE) in evaluating and treating small-bowel diseases. We sought to determine the diagnostic and therapeutic yield of SBE in patients with suspected small-bowel disorders, as well as the impact of preceding capsule endoscopy (CE) on these outcomes. We performed a retrospective analysis of a prospectively collected database at a tertiary-care academic medical center between 2011 and 2013 for all patients referred for SBE. A total of 150 patients underwent 170 SBE procedures during the study period. The most frequent indications for SBE included anemia, overt or occult gastrointestinal bleeding, and suspected mass. CE was performed prior to SBE in 113 of 150 patients (75 %). The overall diagnostic yield for small-bowel disease by CE was 62 %. Therapeutic interventions included hemostasis, polypectomy, and foreign body removal. Total diagnostic and therapeutic yield of SBE was 60 and 28 %, respectively. The diagnostic yield of SBE with prior CE was 68 versus 44 % for SBE without prior CE (P = 0.002). The therapeutic yield of SBE with prior CE was 35 versus 12 % without prior CE (P = 0.001). One endoscopic complication was observed out of 170 procedures, and there were no deaths. SBE appears to be a safe and effective technique for the diagnosis and treatment of small-bowel disease; however, we recommend performing a CE prior to SBE to improve the diagnostic and therapeutic yield of the procedure.