Safety and efficacy of double-balloon enteroscopy in pediatric patients

Background: Although double-balloon enteroscopy (DBE) is performed increasingly often in adults, few findings are available oil the use of DBE in pediatric patients in the published literature. Objectives: The aim Of Our study was to evaluate the safety and efficacy of DBE in pediatric patients. Design: A retrospective database review. Setting and Patients: A database analysis was performed on all pediatric patients (18 years old Or Younger) who underwent DBE at the Jichi Medical University Hospital between September 2000 and October 2008 selected from a total of 825 patients. Main Outcome Measurements: Clinical utility and safety of DBE in pediatric patients. Results: A total of 92 procedures were performed in 48 patients (27 male, 21 female) with a median age (range) of 12.2 (4-18) years. DBE was performed with the patients under general anesthesia in 43 procedures and under moderate sedation in 49 procedures. The most common indication for DBE was treatment of a stricture of a biliary anastomosis after living-donor liver transplantation with establishment of Roux-en-Y hepaticojejunostomy (23 patients). Endoscopic retrograde cholangiography using DBE was performed, and endoscopic therapy could be performed successfully in 13 (56%) patients. The second most common indication was obscure GI bleeding (10 patients); the lesions responsible for the bleeding were found in 7 (70%) patients. Other indications included surveillance and treatment of hereditary polyposis syndromes (5 patients), abdominal pain (4 patients), and inflammatory bowel disease (2 patients). The overall diagnostic yield was 65% (31 of the 48 patients). Post-polypectomy bleeding Occurred in 1 case, but no other complications such as perforation and pancreatitis were observed. Limitations: Small number of patients, participation bias, and single center's experience. Conclusions: DBE is a safe and clinically useful endoscopic procedure in pediatric patients. (Gastrointest Endosc 2010;71:287-94.)