The role of double-balloon enteroscopy in diagnosis and management of incomplete small-bowel obstruction

Background and study aims: Double-balloon enteroscopy (DBE) is a newly developed endoscopic technique for investigating various small-bowel diseases. The aim of this study was to evaluate the diagnostic yield and therapeutic impact of DBE in patients with incomplete small-bowel obstruction (SBO). Patients and methods: This study is a prospective analysis of 45 consecutive patients specifically referred to our hospital between December 2004 and January 2006 for investigation of incomplete SBO that had been confirmed by both clinical symptoms and imaging tests. Patients with a high suspicion of postoperative adhesion were excluded and DBE was performed in stable patients. The final management was guided by the results of DBE and radiographic studies. Demographic, clinical, procedural, and outcome data were collected for analysis. Results: A total of 30 DBEs were performed in 29 patients (11 women, 18 men; mean age 52.0 +/- 13.5 years). DBE identified causes of incomplete SBO in 27 patients (93.1 %) and allowed histopathologic evaluation in 17 patients (58.6%). The more common abnormalities detected were small-bowel tumors (48.3 %) and strictures caused by Crohn's disease (24.1 %). In detecting small-bowel abnormalities, DBE showed a sensitivity of 96.4%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 50%. DBE influenced the therapeutic strategy in 41.4% of patients by adding more information regarding appropriate treatment. Follow-up data were obtained for 26 patients (89.7%), for a mean 9.4 months (range 4-18 months). Of the 26 patients with follow-up, 21 (72.4%) had no further SBO. Conclusions: Double-balloon enteroscopy is a feasible diagnostic tool for detecting the causes of incomplete SBO in patients without a history of abdominal surgery and also influences therapy in patients without a definite cause detected by conventional radiography.