New balloon-guided technique for deep small-intestine endoscopy using standard endoscopes

Background and study aims: The advent of capsule endoscopy has opened the entire small bowel to direct inspection. The identification of pathology often requires diagnostic and therapeutic interventions. The available means today are push enteroscopy (limited to the proximal small bowel), intraoperative enteroscopy (invasive) and push-pull double-balloon enteroscopy (very effective but requires an expensive dedicated system). The aim of this study was to test the safety and efficacy of a novel push-pull technique, balloon-guided endoscopy (BGE), which can be used with standard endoscopic equipment. Patients and methods: Twenty patients with various disorders of the small intestine were examined by BGE. Various endoscopes were used and insertion depth was measured as is customary in double-balloon enteroscopy, by adding together the length of all the insertions of the endoscope performed during the push-pull steps. Results: In 17 peroral intubations of the small bowel the average insertion depth beyond the ligament of Treitz was 1.45 m; insertion depth ranged from 0.80 m to 2.65 m. BGE advancement was deeper than in published results for push enteroscopy, though not equaling those for double-balloon enteroscopy. In the three transanal procedures the ileocecal valve was traversed and the terminal ileum intubated. No severe adverse events occurred. Conclusions: BGE is safe. BGE enables deep intubation of the small bowel beyond the ligament of Treitz utilizing standard endoscopes. Insertion depth with this technique is beyond that achieved by push enteroscopy. Further studies are needed, and technical improvements will lead to deeper insertion.