Clinical Endoscopy

Original Article

Risk factors for recurrent stenosis after balloon dilation for benign hepaticojejunostomy anastomotic stricture: Takafumi Mie, Takashi Sasaki, Takeshi Okamoto, Tsuyoshi Takeda, Chinatsu Mori, Yuto Yamada, Takaaki Furukawa, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira; Clin Endosc 2024;57(2):253-262. Published online May 16, 2023; DOI: https://doi.org/10.5946/ce.2022.216

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Hepaticojejunostomy anastomotic stricture (HJAS) is a feared adverse event associated with hepatopancreatobiliary surgery. Although balloon dilation for benign HJAS during endoscopic retrograde cholangiopancreatography with balloon-assisted enteroscopy has been reported to be useful, the treatment strategy remains controversial. Therefore, we evaluated the outcomes and risk factors of recurrent stenosis after balloon dilation alone for benign HJAS.
Methods
We retrospectively analyzed consecutive patients who underwent balloon-assisted enteroscopy–endoscopic retrograde cholangiopancreatography for benign HJAS at our institution between July 2014 and December 2020.
Results
Forty-six patients were included, 16 of whom had recurrent HJAS after balloon dilation. The patency rates at 1 and 2 years after balloon dilation were 76.8% and 64.2%, respectively. Presence of a residual balloon notch during balloon dilation was an independent predictor of recurrence (hazard ratio, 2.80; 95% confidence interval, 1.01–7.78; p=0.048), whereas HJAS within postoperative 1 year tended to be associated with recurrence (hazard ratio, 2.43; 95% confidence interval, 0.85–6.89; p=0.096). The patency rates in patients without a residual balloon notch were 82.1% and 73.1% after 1 and 2 years, respectively.
Conclusions
Balloon dilation alone may be a viable option for patients with benign HJAS without residual balloon notches on fluoroscopy.

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Reviews

A practical approach for small bowel bleeding: Sung Eun Kim, Hyun Jin Kim, Myeongseok Koh, Min Cheol Kim, Joon Sung Kim, Ji Hyung Nam, Young Kwan Cho, A Reum Choe, The Research Group for Capsule Endoscopy and Enteroscopy of the Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2023;56(3):283-289. Published online May 11, 2023; DOI: https://doi.org/10.5946/ce.2022.302

Abstract PDF PubReader ePub

Gastrointestinal (GI) bleeding is one of the most common conditions among patients visiting emergency departments in Korea. GI bleeding is divided into upper and lower GI bleeding, according to the bleeding site. GI bleeding is also divided into overt and occult GI bleeding based on bleeding characteristics. In addition, obscure GI bleeding refers to recurrent or persistent GI bleeding from a source that cannot be identified after esophagogastroduodenoscopy or colonoscopy. The small intestine is the largest part of the alimentary tract. It extends from the pylorus to the cecum. The small intestine is difficult to access owing to its long length. Moreover, it is not fixed to the abdominal cavity. When hemorrhage occurs in the small intestine, the source cannot be found in many cases because of the characteristics of the small intestine. In practice, small-intestinal bleeding accounts for most of the obscure GI bleeding. Therefore, in this review, we introduce and describe systemic approaches and examination methods, including video capsule endoscopy and balloon enteroscopy, that can be performed in patients with suspected small bowel bleeding in clinical practice.

Citations

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Effect of Different Types of Antithrombotic Agents on Clinical Outcomes in Patients With Small Bowel Bleeding Who Underwent Balloon‐Assisted Enteroscopy: A KASID Multicenter Study
Jihye Park, Jin Su Kim, Joo Hye Song, Kwangwoo Nam, Seong‐Eun Kim, Eui Sun Jeong, Jae Hyun Kim, Seong Ran Jeon
Journal of Gastroenterology and Hepatology.2025; 40(2): 456. CrossRef
Do all antithrombotic agents have a similar impact on small bowel bleeding?
Chung Hyun Tae, Ki-Nam Shim
Clinical Endoscopy.2025; 58(1): 80. CrossRef
Balloon-assisted enteroscopy in the management of adult small-bowel intussusception: a comparative analysis of with and without double-balloon enteroscopy
Won Shik Kim, Beom Jae Lee, Moon Kyung Joo, Seung Han Kim, Jong-Jae Park
Surgical Endoscopy.2025; 39(3): 2044. CrossRef
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Sohaib Asif, Yajun Ying, Tingting Qian, Jun Yao, Jinjie Qu, Vicky Yang Wang, Rongbiao Ying, Dong Xu, Mohamadreza (Mohammad) Khosravi
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Manejo da hemorragia digestiva baixa na emergência: abordagem cirúrgica
Carla Azevedo Zaibak, Sara Monteiro Barbosa, Nathalia Machado De Lima, Jordane Lula Cruz, Angela Maria Pereira Costa, Maria Eduarda da Silva Borges, Mariana Vasconcellos De Oliveira, Danyelly Rodrigues Machado
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Hajin Lee, Younghee Choe, Jung Heo, Gwkang Hui Park, Su Young Lee, Young Wook Cho, Hyo Suk Kim
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Aortoduodenal fistula bleeding caused by an aortic stent graft
Seunghyun Hong, Gwang Ha Kim
Clinical Endoscopy.2024; 57(3): 407. CrossRef
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Nikos Viazis, Dimitris Christodoulou, Vasilis Papastergiou, Konstantinos Mousourakis, Dimitra Kozompoli, Giannis Stasinos, Konstantina Dimopoulou, Periklis Apostolopoulos, Fotios Fousekis, Christos Liatsos, Nikolaos Kyriakos, Theodoros Argyropoulos, Georg
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Difficult Small Bowel Bleeding in Surgical View
Jung Min Bae
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Jejunal Dieulafoy’s lesion resembling subepithelial mass resulting in profound gastrointestinal hemorrhage
Thanaboon Chaemsupaphan, Tanawat Geeratragool, Napat Angkathunyakul, Arissa Phothisirisakulwong, Monthira Maneerattanaporn
Clinical Endoscopy.2024; 57(4): 552. CrossRef

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Single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: a technical review: Yuki Tanisaka, Masafumi Mizuide, Akashi Fujita, Rie Shiomi, Takahiro Shin, Kei Sugimoto, Shomei Ryozawa; Clin Endosc 2023;56(6):716-725. Published online April 17, 2023; DOI: https://doi.org/10.5946/ce.2023.023

Abstract PDF Supplementary Material PubReader ePub

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is technically challenging. For example, scope insertion, selective cannulation, and intended procedures, such as stone extraction or stent placement, can be difficult. Single-balloon enteroscopy (SBE)-assisted ERCP has been used to effectively and safely address these technical issues in clinical practice. However, the small working channel limits its therapeutic potential. To address this shortcoming, a short-type SBE (short SBE) with a working length of 152 cm and a channel of 3.2 mm diameter has recently been introduced. Short SBE facilitates the use of larger accessories to complete certain procedures, such as stone extraction or self-expandable metallic stent placement. Despite the development in the SBE endoscope, various steps have to be overcome to successfully perform such procedure. To improve success, the challenging factors of each procedure must be identified. At the same time, endoscopists need to be mindful of adverse events, such as perforation, which can arise due to adhesions specific to the surgically altered anatomy. This review discussed technical tips regarding SBE-assisted ERCP in patients with surgically altered anatomy to increase success and reduce the risk of adverse events associated with ERCP.

Citations

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Clinical outcomes of endoscopic retrograde cholangiopancreatography after Billroth II anastomosis: a comparison of gastroscope and duodenoscope
Kang Ho Lee, Gwang Hyo Yim, Jimin Han, Han Taek Jeong
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Yuki Tanisaka, Robert Hawes
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Masaaki Shimatani, Toshiyuki Mitsuyama, Takeshi Yamashina, Masahiro Takeo, Shunsuke Horitani, Natsuko Saito, Hironao Matsumoto, Masahiro Orino, Masataka Kano, Takafumi Yuba, Takuya Takayama, Tatsuya Nakagawa, Shoji Takayama
DEN Open.2024;[Epub] CrossRef
Efficacy of texture and color enhancement imaging for short‐type single‐balloon enteroscopy‐assisted biliary cannulation in patients with Roux‐en‐Y gastrectomy: Multicenter study (with video)
Yuki Tanisaka, Mamoru Takenaka, Masafumi Mizuide, Akashi Fujita, Ryuhei Jinushi, Takahiro Shin, Kei Sugimoto, Ken Kamata, Kosuke Minaga, Shunsuke Omoto, Tomohiro Yamazaki, Shomei Ryozawa
Digestive Endoscopy.2024; 36(9): 1030. CrossRef
Progress in minimally invasive treatment of biliary pancreatic duct obstruction after digestive tract reconstruction by endoscopic retrograde cholangiopancreatography
Ru-Yi Wang, Zhen Fan
World Chinese Journal of Digestology.2024; 32(7): 490. CrossRef
Endoscopic Management of Biliary and Pancreatic Pathologies in Roux-en-Y Gastric Bypass Patients: Development of a Treatment Algorithm Based on 9-Year Experience
Laurent Monino, Lancelot Marique, Yannick Deswysen, Maximilien Thoma, Pierre H. Deprez, Pierre Goffette, Benoit Navez, Tom G. Moreels
Obesity Surgery.2024; 34(10): 3717. CrossRef
Use of short single-balloon enteroscopy in patients with surgically altered anatomy: a single-center experience
Songming Ding, Shanjie Dong, Hengkai Zhu, Yiting Hu, Shusen Zheng, Qiyong Li
Scientific Reports.2024;[Epub] CrossRef
Emergency Laparoscopic Common Bile Duct Exploration for Acute Cholangitis in Cases with Difficulty with an Endoscopic Approach
Naoki Matsumoto, Isao Sato, Yoshihide Chino, Makoto Mizutani, Tomotake Tabata, Tomoyuki Tagi, Shigeyoshi Shimaoka, Takafumi Oe
The Japanese Journal of Gastroenterological Surgery.2024; 57(11): 535. CrossRef
Development and evaluation of artificial organ models for ERCP training in patients with surgically altered anatomies
Kai Koch, Benedikt Duckworth-Mothes, Ulrich Schweizer, Karl-Ernst Grund, Tom G. Moreels, Alfred Königsrainer, Dörte Wichmann
Scientific Reports.2023;[Epub] CrossRef
Simplified single-session EUS-guided transhepatic antegrade stone removal for management of choledocholithiasis in patients with surgically altered anatomy
Tingting Yu, Suning Hou, Haiming Du, Wei Zhang, Jiao Tian, Yankun Hou, Jun Yao, Senlin Hou, Lichao Zhang
Gastroenterology Report.2023;[Epub] CrossRef

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Original Article

Endoscopic and histological characteristics of small bowel tumors diagnosed by double-balloon enteroscopy: Suleyman Dolu, Soner Onem, Zarni Htway, Farid Hajıyev, Ali Bilgen, Hatice Cilem Binicier, Ecem Kalemoglu, Ozgul Sagol, Mesut Akarsu; Clin Endosc 2023;56(1):83-91. Published online October 27, 2022; DOI: https://doi.org/10.5946/ce.2022.131

Abstract PDF PubReader ePub

Background
/Aims: Double-balloon enteroscopy (DBE) allows for the diagnoses and treatment of small bowel tumors (SBTs). This study aimed to evaluate the utility of DBE for the diagnosis and treatment of SBTs.
Methods
Patients diagnosed with SBTs who underwent DBE were included in this study. According to their endoscopic appearances, they were categorized as polyps or masses, and according to their histological characteristics, they were categorized as benign or malignant SBTs.
Results
A total of 704 patients were retrospectively analyzed, and 90 (12.8%) were diagnosed with SBTs. According to their endoscopic appearance, 48 (53.3%) had polyps and 42 (46.7%) had masses. Additionally, 53 (58.9%) and 37 (41.1%) patients had malignant and benign SBTs, respectively, depending on their histological characteristics. Patients diagnosed with polyps were younger than those diagnosed with masses (p<0.001). Patients diagnosed with benign SBTs were younger than those diagnosed with malignant SBT (p<0.001). Overall, histological diagnosis was determined using DBE in 73 (81.1%) patients.
Conclusions
DBE is a useful method for diagnosing SBTs. Additionally, the histological type of the lesion can be determined using DBE.

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Effectiveness of Double Balloon Enteroscopy in the Diagnosis and Treatment of Small Bowel Varices
Suleyman Dolu, Mehmet Emin Arayici, Soner Onem, Ilker Buyuktorun, Huseyin Dongelli, Goksel Bengi, Mesut Akarsu
Diagnostics.2025; 15(3): 336. CrossRef
Balloon-assisted enteroscopy in the management of adult small-bowel intussusception: a comparative analysis of with and without double-balloon enteroscopy
Won Shik Kim, Beom Jae Lee, Moon Kyung Joo, Seung Han Kim, Jong-Jae Park
Surgical Endoscopy.2025; 39(3): 2044. CrossRef
Diagnostic and Clinical Impact of Double-Balloon Enteroscopy in Small-Bowel Inflammatory Lesions: A Retrospective Cohort Study in a Turkish Population
Suleyman Dolu, Mehmet Emin Arayici, Soner Onem, Huseyin Dongelli, Mesut Akarsu
Diagnostics.2025; 15(6): 661. CrossRef
Small Bowel Tumors: A 7-Year Study in a Tertiary Care Hospital
Sergiu Marian Cazacu, Dan Cârțu, Mihai Popescu, Liliana Streba, Bogdan Silviu Ungureanu, Vlad Florin Iovănescu, Mihai Cimpoeru, Cecil Sorin Mirea, Valeriu Marian Surlin, Stelian Mogoantă, Mirela Marinela Florescu
Cancers.2025; 17(9): 1465. CrossRef

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Systematic Review and Meta-Analysis

Stent versus Balloon Dilation for the Treatment of Dominant Strictures in Primary Sclerosing Cholangitis: A Systematic Review and Meta-Analysis: Marina Tucci Gammaro Baldavira Ferreira, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Thomas R. McCarty, Alberto Machado da Ponte Neto, Galileu Ferreira Ayala Farias, Antônio Afonso de Miranda Neto, Pedro Victor Aniz Gomes de Oliveira, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura; Clin Endosc 2021;54(6):833-842. Published online July 1, 2021; DOI: https://doi.org/10.5946/ce.2021.052

Abstract PDF PubReader ePub

Background
/Aims: The endoscopic management of primary sclerosing cholangitis (PSC)-associated dominant strictures remains challenging. This systematic review and meta-analysis aimed to compare balloon dilation and stent placement in the treatment of dominant strictures among PSC patients.
Methods
Literature searches on MEDLINE, EMBASE, Cochrane CENTRAL and Lilacs/Bireme were performed for studies published until December 2020. Measured outcomes included clinical efficacy, stricture recurrence, cumulative recurrencefree rate, transplant rate, 5-year survival rate, and adverse events (i.e., pancreatitis, cholangitis, bleeding, perforation and death).
Results
A total of 5 studies (n=467) were included. Based on pooled analyses, there were no differences in clinical efficacy (risk difference [RD], -0.13; 95% confidence interval [CI], -0.58 to 0.33; I²=93%) or transplant rates (RD, -0.09; 95% CI, -0.19 to 0.01; I²=0%); however, the risk of occurrence of adverse events was lower with balloon dilatation than with stent placement (RD,-0.34; 95% CI, -0.45 to -0.23; I²=61%). Among the types of adverse events reported, only the rates of cholangitis/bacteremia were significantly lower in balloon dilation patients (RD, -0.19; 95% CI, -0.25 to -0.13; I²=51%).
Conclusions
Compared to balloon dilation, stent placement for dominant strictures in PSC appeared to have higher complication rates without significant differences in efficacy.

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Primary sclerosing cholangitis
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Case Report

Management of Biliopancreatic Limb Bleeding after Roux-en-Y Gastric Bypass: A Case Report: Christophe Riquoir, Luis Antonio Díaz, David Chiliquinga, Roberto Candia, Fernando Pimentel, Alex Arenas; Clin Endosc 2021;54(5):754-758. Published online May 25, 2021; DOI: https://doi.org/10.5946/ce.2021.060

Abstract PDF PubReader ePub

The Roux-en-Y gastric bypass is one of the most extensive surgical treatments for obesity. The treatment of upper gastrointestinal bleeding after Roux-en-Y gastric bypass is complex due to the difficulty of accessing the excluded gastric antrum and duodenal bulb. There is no consensus regarding the management of this complication. While various techniques have been described to access the biliopancreatic limb, double-balloon enteroscopy is the most commonly used. If double-balloon enteroscopy is unavailable, a pediatric colonoscope may be used as an alternative; however, its use in such cases has not been described. We report the case of a 50-year-old male patient who underwent gastric bypass 13 years ago and was admitted for a second episode of upper gastrointestinal bleeding. The initial approach using upper endoscopy, colonoscopy, and abdominal computed tomography angiography did not reveal the cause of gastrointestinal hemorrhage; therefore, an endoscopic study of the biliopancreatic limb was performed using a pediatric colonoscope. A Forrest Ib ulcer was found in the duodenal bulb, and endoscopic therapy was administered. The evolution was found to be satisfactory.

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Abdominal apoplexy: a rare complication following Roux-en-Y gastric bypass
Stephanie Alexander, Trent Cross
International Surgery Journal.2025;[Epub] CrossRef
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Sung Hyeok Ryou, Ki Bae Bang
Clinical Endoscopy.2023; 56(6): 706. CrossRef

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FOCUSED REVIEW SERIES: Endoscopic Managements for Patients with Obesity and Its Related Comorbidities

The Clinical and Metabolic Effects of Intragastric Balloon on Morbid Obesity and Its Related Comorbidities: Joon Hyun Cho, Mohammad Bilal, Min Cheol Kim, Jonah Cohen, The Study Group for Endoscopic Bariatric and Metabolic Therapies of the Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2021;54(1):9-16. Published online January 29, 2021; DOI: https://doi.org/10.5946/ce.2020.302

Abstract PDF PubReader ePub

Obesity is becoming increasingly prevalent worldwide, and its metabolic sequelae lead to a significant burden on healthcare resources. Options for the management of obesity include lifestyle modification, pharmacological treatment, surgery, and endoscopic bariatric therapies (EBTs). Among these, EBTs are more effective than diet and lifestyle modification and are less invasive than bariatric surgery. In recent years, there have been significant advances in technologies pertaining to EBTs. Of all the available EBTs, there is a significant amount of clinical experience and published data regarding intragastric balloons (IGBs) because of their comparatively long development period. Currently, the United States Food and Drug Administration (FDA) has approved three IGBs, including Orbera (Apollo Endosurgery, Austin, TX, USA), ReShape Duo (ReShape Medical, San Clemente, CA, USA), and Obalon (Obalon Therapeutics, Carlsbad, CA, USA). The aim of this review is to summarize the available literature on the efficacy of IGBs in weight loss and their impact on obesity-related metabolic diseases.

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Focused Review Series: Present and Future of Diagnosis and Management of Small Bowel Diseases Exploiting Artificial Intelligence and Advanced Endoscopy

Roles of Capsule Endoscopy and Balloon-Assisted Enteroscopy in the Optimal Management of Small Bowel Bleeding: Hani Abutalib, Tomonori Yano, Satoshi Shinozaki, Alan Kawarai Lefor, Hironori Yamamoto; Clin Endosc 2020;53(4):402-409. Published online July 30, 2020; DOI: https://doi.org/10.5946/ce.2020.143

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The small bowel had long been considered a dark unapproachable tunnel until the invention of capsule endoscopy and doubleballoon enteroscopy in the 21st century, which revolutionized the diagnosis and management of small bowel diseases, including bleeding. Various imaging modalities such as computed tomographic enterography, angiography, capsule endoscopy, and balloonassisted enteroscopy play vital roles in the diagnosis and management of small bowel bleeding. The choice of modality to use and timing of application differ according to the availability of the modalities, patient’s history, and physician’s experience. Small bowel bleeding is managed using different strategies as exemplified by medical treatment, interventional radiology, endoscopic therapy, or surgical intervention. Balloon-assisted enteroscopy enables endoscopic interventions to control small bowel bleeding, including electrocautery, argon plasma coagulation, clip application, and tattooing as a prelude to surgery. In this article, we clarify the recent approaches to the optimal diagnosis and management of patients with small bowel bleeding.

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Hemangioma capilar del yeyuno como causa de sangrado agudo: reporte de caso y revisión de la literatura
Martín Alonso Gómez Zuleta, Diego Alexander Cardona Botero, Juan Antonio Trejos Naranjo, Felipe Vera Polanía
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Wei Yang, Zheng Li, Rui Liu, Xudong Tong, Wei Wang, Dongqiang Xu, Shan Gao
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Focused Review Series: The Roles of Endoscopy in the Management of Colonic Obstruction and Perforation

Endoscopic Management of Benign Colonic Obstruction and Pseudo-Obstruction: Su Jin Jeong, Jongha Park; Clin Endosc 2020;53(1):18-28. Published online October 24, 2019; DOI: https://doi.org/10.5946/ce.2019.058

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There are a variety of causes of intestinal obstruction, with the most common cause being malignant diseases; however, volvulus, inflammatory bowel disease or diverticulitis, radiation injury, ischemia, and pseudo-obstruction can also cause colonic obstruction. These are benign conditions; however, delayed diagnosis of acute intestinal obstruction owing to these causes can cause critical complications, such as perforation. Therefore, high levels of clinical suspicion and appropriate treatment are crucial. There are variable treatment options for colonic obstruction, and endoscopic treatment is known to be a less invasive and an effective option for such. In this article, the authors review the causes of benign colonic obstruction and pseudo-obstruction and the role of endoscopy in treating them.

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Focused Review Series: Updates on endoscopic bariatric and metabolic therapies

Various Intragastric Balloons Under Clinical Investigation: Seong Ji Choi, Hyuk Soon Choi; Clin Endosc 2018;51(5):407-415. Published online September 27, 2018; DOI: https://doi.org/10.5946/ce.2018.140

Abstract PDF PubReader ePub

Obesity is a chronic disease with an exponentially increasing incidence rate, and its negative effects are well documented in numerous studies. As a result, the importance of bariatric therapy cannot be overemphasized, and many bariatric treatment methods with varying mechanisms have been developed. Of the available treatment methods, intragastric balloons, introduced in the 1980s, have been shown to be a safe and effective treatment modality; various intragastric balloon products have been developed and are currently being widely used in clinical settings. However, the disadvantages of intragastric balloons, such as unclear long-term weight loss benefits and complications experienced during insertion and removal, preclude their wider use. In this review, we discuss different intragastric balloon products, focusing on those under clinical investigation, and suggest future research directions.

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Case Reports

Gastric Ulceration and Bleeding with Hemodynamic Instability Caused by an Intragastric Balloon for Weight Loss: Larrite Reed, Hawa Edriss, Kenneth Nugent; Clin Endosc 2018;51(6):584-586. Published online June 1, 2018; DOI: https://doi.org/10.5946/ce.2018.038

Abstract PDF PubReader ePub

Obesity in the United States is a medical crisis with many people attempting to lose weight with caloric restriction. Some patients choose minimally invasive weight loss solutions, such as intragastric balloon systems. These balloon systems were approved by the Federal Drug Administration (FDA) in 2015–2016 and have been considered safe, with minimal side effects. We report a patient with a two-day history of melena, abdominal pain, hypotension, and syncope which developed five months after placement of an intragastric balloon. Esophagogastroduodenoscopy with balloon removal revealed a small 8-mm gastric ulcer in the incisura. This gastric ulcer probably developed secondary to mechanical compression of the stomach mucosa by the gastric balloon which contained 900 mL of saline. The FDA is now investigating five deaths since 2016 associated with these second-generation balloons. Clinicians should be aware of these complications when evaluating patients with gastrointestinal complications, such as bleeding.

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Gastric Perforation Secondary to a Hyperinflated Intragastric Balloon: A Case Report and Management Approach
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Metal Stent Placement in the Afferent Loop Obstructed by Peritoneal Metastases—Experience of Five Cases: Yoshihide Kanno, Tetsuya Ohira, Yoshihiro Harada, Yoshiki Koike, Taku Yamagata, Megumi Tanaka, Tomohiro Shimada, Kei Ito; Clin Endosc 2018;51(3):299-303. Published online April 18, 2018; DOI: https://doi.org/10.5946/ce.2018.005

Abstract PDF PubReader ePub

Afferent loop syndrome is often difficult to resolve. Among patients with afferent loop syndrome whose data were extracted from databases, 5 patients in whom metal stent placement was attempted were included and evaluated in this study. The procedure was technically successful without any adverse events in all patients. Metal stent(s) was placed with an endoscope in the through-the-scope manner in 4 patients and via a percutaneous route in 1 patient. Obvious clinical efficacy was observed in all patients. Adverse events related to the procedure and stent occlusion during the follow-up period were not observed. Metal stent placement for malignant obstruction of the afferent loop was found to be safe and feasible.

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Early and late effects of endoscopic interventions in patients with malignant afferent loop syndrome: A single‐center experience and literature review
Kenjiro Yamamoto, Takao Itoi, Yukitoshi Matsunami, Atsushi Sofuni, Takayoshi Tsuchiya, Shuntaro Mukai, Hiroyuki Kojima, Hirohito Minami, Ryosuke Nakatsubo, Ryosuke Tonozuka
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Yuya Hagiwara, Susumu Hijioka, Yoshikuni Nagashio, Yuta Maruki, Akihiro Ohba, Yuki Kawasaki, Kotaro Takeshita, Tetsuro Takasaki, Daiki Agarie, Hidenobu Hara, Shin Yagi, Soma Fukuda, Masaru Kuwada, Daiki Yamashige, Kohei Okamoto, Mark Chatto, Shunsuke Kond
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DEN Open.2023;[Epub] CrossRef
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Usefulness of endoscopic metal stent placement for malignant afferent loop obstruction
Akihiko Kida, Hidenori Kido, Toshiki Matsuo, Atsuyoshi Mizukami, Masaaki Yano, Fumitaka Arihara, Koichiro Matsuda, Kohei Ogawa, Mitsuru Matsuda, Akito Sakai
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Arata Sakai, Hideyuki Shiomi, Takao Iemoto, Ryota Nakano, Takuya Ikegawa, Takashi Kobayashi, Atsuhiro Masuda, Yuzo Kodama
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Yuning Cao, Xiangheng Kong, Daogui Yang, Senlin Li
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Kei Yane, Akio Katanuma, Tsuyoshi Hayashi, Kuniyuki Takahashi, Toshifumi Kin, Kazumasa Nagai, Kazunari Tanaka, Naohiro Komatsu, Masato Endo, Yousuke Kobayashi, Yukiko Takigawa, Ran Utsunomiya
Endoscopy International Open.2018; 06(11): E1330. CrossRef

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Laparoscopic Resection of a Jejunal Inflammatory Fibroid Polyp that Caused Occult Gastrointestinal Bleeding, Diagnosed via Capsule Endoscopy and Double-Balloon Enteroscopy: A Case Report: Chizu Kameda, Hideaki Miwa, Ryohei Kawabata, Daiki Marukawa, Masahiro Murakami, Shingo Noura, Junzo Shimizu, Junichi Hasegawa; Clin Endosc 2018;51(4):384-387. Published online March 20, 2018; DOI: https://doi.org/10.5946/ce.2017.162

Abstract PDF PubReader ePub

An inflammatory fibroid polyp (IFP) is a mesenchymal tumor of the gastrointestinal tract. IFPs in the small intestine are the most frequently detected with symptoms, such as abdominal pain and tarry stool due to intussusception. Accordingly, few studies have reported jejunal IFP as a cause of occult gastrointestinal bleeding (OGIB) diagnosed via both of capsule endoscopy (CE) and double-balloon enteroscopy (DBE). A 68-year-old woman presented with a progression of anemia and a positive fecal occult blood test result. Esophagogastroduodenoscopy and total colonoscopy findings were unremarkable. CE revealed a tumor with bleeding in the jejunum. DBE also revealed a jejunal polypoid tumor. Bleeding from the tumor seemed to have caused anemia. The patient underwent partial laparoscopic resection of the jejunum, including resection of the tumor. The tumor was histopathologically diagnosed as IFP. To our knowledge, this is the first reported case of laparoscopic resection of jejunal IFP with OGIB diagnosed via CE and DBE preoperatively.

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World Journal of Surgical Oncology.2019;[Epub] CrossRef

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Original Article

Double-Balloon Endoscopy after Incomplete Colonoscopy and Its Comparison with Computed Tomography Colonography: Carlijn Hermans, Dennis van der Zee, Lennard Gilissen; Clin Endosc 2018;51(1):66-71. Published online January 10, 2018; DOI: https://doi.org/10.5946/ce.2017.011

Abstract PDF PubReader ePub

Background
/Aims: Because of the national screening program for colorectal carcinoma in The Netherlands, the number of colonoscopies has increased. In case of incomplete colonoscopy, computed tomography colonography (CTC) and double-balloon colonoscopy (DBc) are alternative options. This study evaluated cecal intubation rate and pathology detection rate in the previously unexplored part of the colon, complication rate of DBc, and CTC results after incomplete colonoscopy.
Methods
Retrospective observational study in a tertiary referral hospital regarding DBc and CTC reports from cases with incomplete colonoscopy.
Results
Sixty-three DBcs were performed after incomplete colonoscopy. Cecal intubation rate was 95%. Detection rate was 58% (5% carcinoma and 3% high-grade dysplastic adenoma). CTC preceded 54% of DBcs and 62% of CTC findings were confirmed. In 16%, a biopsy was taken, and in 60%, an intervention (mostly polypectomy) was performed. One major complication (1.5%) occurred, i.e., arterial bleeding due to polypectomy necessitating right hemicolectomy. CTC (n=213) showed a possible lesion in 35%, and could be confirmed by follow-up endoscopy or surgery in 65%.
Conclusions
DBc is effective and safe for completion of colon inspection in incomplete colonoscopy. In patients with a high likelihood of pathology, DBc is preferred over CTC.

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Lu He, Liang Guo, Chunhong Hu
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Review

Recent Development of Techniques and Devices in Colorectal Endoscopic Submucosal Dissection: Hiroya Mizutani, Satoshi Ono, Daisuke Ohki, Chihiro Takeuchi, Seiichi Yakabi, Yosuke Kataoka, Itaru Saito, Yoshiki Sakaguchi, Chihiro Minatsuki, Yosuke Tsuji, Keiko Niimi, Shinya Kodashima, Nobutake Yamamichi, Mitsuhiro Fujishiro, Kazuhiko Koike; Clin Endosc 2017;50(6):562-568. Published online November 30, 2017; DOI: https://doi.org/10.5946/ce.2017.108

Abstract PDF PubReader ePub

Colorectal endoscopic submucosal dissection (ESD) is now a well-established endoscopic treatment for early-stage colorectal neoplasms, especially in Asian countries, including Japan. Despite the spread of colorectal ESD, there are still situations in which achieving successful submucosal dissection is difficult. Various novel techniques and devices have been developed to overcome these difficulties, and past reports have shown that some of these strategies can be applied to colorectal ESD. We review several recent developments in the field. The techniques reviewed include the pocket creation method and traction methods and the devices reviewed include the overtube with balloon and electrosurgical knives with water-jet function. These improved techniques and devices can facilitate safer, more reliable ESDs and expand its applicability and acceptability all over the world.

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Focused Review Series: Current Statuses of Endoscopy in the Management of Inflammatory Bowel Disease

Endoscopic Balloon Dilation for Crohn’s Disease-Associated Strictures: Thomas Klag, Jan Wehkamp, Martin Goetz; Clin Endosc 2017;50(5):429-436. Published online September 29, 2017; DOI: https://doi.org/10.5946/ce.2017.147

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Management of intestinal strictures associated with Crohn’s disease (CD) is clinically challenging despite advanced medical therapy directed toward mucosal healing to positively influence the natural course of CD-associated complications. Although medical therapy is available for inflammatory strictures, therapy of fibrostenotic strictures is the domain of surgery and endoscopy. Endoscopic balloon dilation (EBD) has been recognized as a well-established first-line procedure in terms of safety and efficacy. Although surgery is a valuable treatment modality for the management of CD-related strictures, EBD can help prevent multiple surgical interventions, which might in the long-term lead to a risk of short bowel syndrome. In this review we discuss requirements, techniques, safety, short- and long-term outcomes, as well as combinations of this procedure with surgical and medical treatment in CD-associated intestinal strictures.

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Balloon-Assisted Enteroscopy and Capsule Endoscopy in Suspected Small Bowel Crohn’s Disease: Hsu-Heng Yen, Chen-Wang Chang, Jen-Wei Chou, Shu-Chen Wei; Clin Endosc 2017;50(5):417-423. Published online September 29, 2017; DOI: https://doi.org/10.5946/ce.2017.142

Abstract PDF PubReader ePub

Inflammatory bowel diseases are idiopathic inflammatory diseases of two main types, Crohn’s disease and ulcerative colitis. Crohn’s disease can affect the entire gastrointestinal tract, and the distal ileum is involved in up to 70% of patients. Moreover, Crohn’s disease in one-quarter to one-third of patients involves isolation of the small bowel. Due to the nonspecific symptoms and anatomical location of the disease, small bowel Crohn’s disease is a phenotype that is particularly difficult to manage. Since the introduction of capsule endoscopy in 2000 and balloon-assisted enteroscopy in the 21st century, it is now possible to directly inspect for small bowel Crohn’s disease. However, the new modalities still have limitations, such as capsule retention and invasiveness of balloon-assisted enteroscopy. The diagnostic yields of both capsule endoscopy and balloon-assisted enteroscopy are high for patients with suspected small bowel Crohn’s disease. Therefore, earlier use of capsule endoscopy or balloon-assisted enteroscopy can help with the diagnosis and earlier treatment of these patients to avert possible disastrous outcomes.

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Focused Review Series: Training in Endoscopy

Training in Endoscopy: Enteroscopy: Jinsu Kim; Clin Endosc 2017;50(4):328-333. Published online July 31, 2017; DOI: https://doi.org/10.5946/ce.2017.089

Abstract PDF PubReader ePub

The balloon-assisted enteroscope has been regarded as the standard device for direct visualization of deep small bowels and allows for the diagnosis and treatment of small bowel disease. At the beginning, its application was focused on the diagnosis of obscure gastrointestinal bleeding, inflammatory bowel disease, and small bowel tumor. However, the indications are being expanded to various therapeutic procedures, not only confined to bleeding control. With the expansion of the indications, the need to perform enteroscopy effectively and safely is increasing. Recent studies have been focused on the diagnostic yield, therapeutic yield, and long-term outcomes of the device. However, with the increasing number of procedures, procedural guidelines and quality indicators are also needed.

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Case Reports

A Case of Primary Small Bowel Melanoma Diagnosed by Single-Balloon Enteroscopy: Jun Young Shin, In Suh Park, Byoung Wook Bang, Hyung Kil Kim, Yong Woon Shin, Kye Sook Kwon; Clin Endosc 2017;50(4):395-399. Published online June 2, 2017; DOI: https://doi.org/10.5946/ce.2016.153

Abstract PDF PubReader ePub

Although metastasis from cutaneous malignant melanoma to the small intestine is not uncommon, primary small bowel melanoma (SBM) is extremely rare. This case report describes a rare case of primary SBM, diagnosed by single-balloon enteroscopy. A 74-year-old man presented with recurrent melena. Upper endoscopy and colonoscopy were unremarkable. Abdominal computed tomography (CT) revealed an ileal mass with ileo-ileal intussusception. Subsequent single-balloon enteroscopy identified an ileal tumor, which was histologically diagnosed as melanoma. Extensive clinical examination did not reveal any primary cutaneous lesions. To the best of our knowledge, this is the first case of primary SBM in South Korea.

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Gastric Perforation Caused by an Intragastric Balloon: Endoscopic Findings: In Kyung Yoo, Hoon Jai Chun, Yoon Tae Jeen; Clin Endosc 2017;50(6):602-604. Published online May 18, 2017; DOI: https://doi.org/10.5946/ce.2017.015

Abstract PDF Supplementary Material PubReader ePub

Intragastric balloon (IGB) insertion has been most frequently used in the West as an effective endoscopic treatment for morbid obesity, in practice. Recently, there is a growing number of cases requiring IGB deployment for obesity treatment in Korea. One of the reported complications of IGB use is gastric perforation. A 47-year-old woman was admitted to the hospital with mild symptoms, 7 weeks after having an IGB placed. Esophagogastroduodenoscopy was performed and gastric ulcer perforation was observed in the ulcer base, where food particles were impacted. Laparoscopic primary repair was done successfully. This was a case of gastric perforation, secondary to poor compliance with a proton-pump inhibitor (PPI). PPI and Helicobacter pylori eradication are important for ulcer prevention following IGB deployment.

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Focused Review Series: Roles of Bariatric Endoscopy in Obesity Treatment

Role of Restrictive Endoscopic Procedures in Obesity Treatment: Hang Lak Lee; Clin Endosc 2017;50(1):17-20. Published online January 30, 2017; DOI: https://doi.org/10.5946/ce.2017.022

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It is well recognized that obesity is a big problem and it can induce large economic burden. Obesity affects about 40% people in the America alone and obesity also is the worldwide problem, with about 400 million obese adults. Moreover, another problem of obesity is the increasing prevalence of overweight children. Though bariatric surgery remains the gold treatment modality in the obesity treatment, endoluminal approaches may have the meaningful role for weight control. Endoscopists should have a role in the management of obesity because endoluminal therapies demonstrate their safety and efficacy over the coming years. Endoluminal therapies can be summarized by above methods: space occupying, malabsorption method, and reduction of gastric volume. In this review, we will introduce various restrictive endoscopic procedures in obesity treatment.

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Original Article

Double-Balloon Endoscopy in Overt and Occult Small Bowel Bleeding: Results, Complications, and Correlation with Prior Videocapsule Endoscopy in a Tertiary Referral Center: Carlijn Hermans, Arnold Stronkhorst, Annemarie Tjhie-Wensing, Jan Kamphuis, Bas van Balkom, Rob Dahlmans, Lennard Gilissen; Clin Endosc 2017;50(1):69-75. Published online January 12, 2017; DOI: https://doi.org/10.5946/ce.2016.079

Abstract PDF PubReader ePub

Background
/Aims: Videocapsule endoscopy (VCE) and double-balloon endoscopy (DBE) allow deep exploration in patients with suspected small bowel pathology. VCE is often performed as an initial small bowel examination to explore whether an intervention by DBE is indicated and to determine insertion route. The study aim was to evaluate the correlation between DBE and VCE in patients with obscure or overt bleeding or anemia, as well as intervention frequency, and complications.
Methods
Retrospective observational study.
Results
DBE procedures (n=205) showed small bowel lesions in 64% cases. Antegrade DBE showed positive results in 79% cases, mostly angiodysplasias (63%). Retrograde DBE showed positive results in 22% cases. An intervention was performed in 64% of DBE procedures. The major complication rate was 0.5%, which was one case of perforation. Pancreatitis did not occur. The overall diagnostic agreement was 66% among the 134 DBEs with preceded VCE.
Conclusions
In cases of overt or occult bleeding or anemia, DBE was positive in 64%, with only a few complications. Positive correlation was 66% among initially performed VCEs and DBEs. Owing to the time-consuming and invasive character of DBE, performing VCE before DBE might still be clinically relevant.

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Predictors for finding lesions in the small bowel by enteroscopy after a positive capsule endoscopy
Juan Manuel Blancas-Valencia, Gerardo Blanco Velasco, Luis Fernando García Contreras, Omar Michel Solórzano-Pineda, Óscar Víctor Hernández-Mondragón
Revista Española de Enfermedades Digestivas.2020;[Epub] CrossRef
Small Bowel Enteroscopy – A Joint Clinical Guideline from the Spanish and Portuguese Small Bowel Study Groups
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Video capsule endoscopy vs double-balloon enteroscopy in the diagnosis of small bowel bleeding: A systematic review and meta-analysis
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Reviews

Diagnostic and Therapeutic Capability of Double-Balloon Enteroscopy in Clinical Practice: Umit Akyuz, Filiz Akyuz; Clin Endosc 2016;49(2):157-160. Published online March 7, 2016; DOI: https://doi.org/10.5946/ce.2015.036

Abstract PDF PubReader ePub

Advances in technology have facilitated the common use of small-bowel imaging. Intraoperative enteroscopy was the gold standard method for small-bowel imaging. However, noninvasive capsule endoscopy and invasive balloon enteroscopy are currently the main endoscopic procedures that are routinely used for small-bowel pathologies, and the indications for both techniques are similar. Although obstruction is a contraindication for capsule endoscopy, it is not considered to be problematic for double-balloon enteroscopy. The most important advantage of double-balloon enteroscopy is the applicability of therapeutic interventions during the procedure; however, double-balloon enteroscopy has certain advantages as well as disadvantages.

Citations

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Development of an earthworm-based soft robot for colon sampling
Gongxin Li, Wei Qiu, Mindong Wang, Yazhou Zhu, Fei Liu
Frontiers in Robotics and AI.2024;[Epub] CrossRef
Role of balloon enteroscopy for obscure gastrointestinal bleeding in those with surgically altered anatomy: A systematic review
Mahmoud Aryan, Tyler Colvin, Ali M Ahmed, Kondal Rao Kyanam Kabir Baig, Shajan Peter
World Journal of Gastrointestinal Endoscopy.2022; 14(7): 434. CrossRef
Development of an Earthworm-Based Intestinal Soft Robot Equipped with a Gripper
Gongxin Li, Wei Qiu, Hao Wen, Mindong Wang, Fei Liu
Machines.2022; 10(11): 1057. CrossRef
Predictors for Small Bowel Stenosis in Balloon-Assisted Enteroscopy
Bai-Rong Li, Tao Sun, Jing Li, Meng Li, Shou-Bin Ning, Xiao-Wei Jin, Ming Zhu, Gao-Ping Mao
Digestive Diseases and Sciences.2020; 65(9): 2630. CrossRef
Enteroscopia de doble balón: indicaciones, abordajes, eficacia diagnóstica y terapéutica y seguridad. Experiencia temprana de un solo centro
J.J.E. García-Correa, J.J. Ramírez-García, L.F. García-Contreras, C. Fuentes-Orozco, L. Irusteta-Jiménez, L.R. Michel-Espinoza, A.S. Carballo Uribe, J.A. Torres Chávez, A. González-Ojeda
Revista de Gastroenterología de México.2018; 83(1): 31. CrossRef
Double-balloon enteroscopy: Indications, approaches, diagnostic and therapeutic yield, and safety. Early experience at a single center
J.J.E. García-Correa, J.J. Ramírez-García, L.F. García-Contreras, C. Fuentes-Orozco, L. Irusteta-Jiménez, L.R. Michel-Espinoza, A.S. Carballo Uribe, J.A. Torres Chávez, A. González-Ojeda
Revista de Gastroenterología de México (English Edition).2018; 83(1): 31. CrossRef
Double-Balloon Endoscopy in Overt and Occult Small Bowel Bleeding: Results, Complications, and Correlation with Prior Videocapsule Endoscopy in a Tertiary Referral Center
Carlijn Hermans, Arnold Stronkhorst, Annemarie Tjhie-Wensing, Jan Kamphuis, Bas van Balkom, Rob Dahlmans, Lennard Gilissen
Clinical Endoscopy.2017; 50(1): 69. CrossRef
Education and Training Guidelines for the Board of the Korean Society of Gastrointestinal Endoscopy
Hee Seok Moon, Eun Kwang Choi, Ji Hyun Seo, Jeong Seop Moon, Ho June Song, Kyoung Oh Kim, Jong Jin Hyun, Sung Kwan Shin, Beom Jae Lee, Sang Heon Lee
Clinical Endoscopy.2017; 50(4): 345. CrossRef

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Diagnosis of Obscure Gastrointestinal Bleeding: Satoshi Tanabe; Clin Endosc 2016;49(6):539-541. Published online February 11, 2016; DOI: https://doi.org/10.5946/ce.2016.004

Abstract PDF PubReader ePub

Obscure gastrointestinal bleeding (OGIB) is defined as gastrointestinal bleeding from a source that cannot be identified on upper or lower gastrointestinal endoscopy. OGIB is considered an important indication for capsule endoscopy (CE). CE is particularly useful for the detection of vascular and small ulcerative lesions, conditions frequently associated with OGIB, particularly in Western countries. On the other hand, balloon enteroscopy (BE) can facilitate the diagnosis of lesions presenting with minimal changes of the mucosal surface, such as submucosal tumors, and can be used not only for diagnosis, but also for treatment, including endoscopic hemostasis. In other words, the complementary use of both CE and BE enables OGIB to be more efficiently diagnosed and treated. However, rebleeding can occur even in patients with negative results of CE, and such patients require repeat CE or BE. It is essential to effectively use both CE and BE based on a thorough understanding of the strong points and weak points of these procedures. Further advances and developments in virtual endoscopy incorporating computed tomography and magnetic resonance imaging are expected in the future.

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Combined morphological and molecular approaches to the clinical diagnosis of Necator americanus infection: a case report
Xianshu Liu, Ailian Sun, Xingxing Zheng, Meng Xia, Yan Liu, Shuaiqin Huang, Xiang Wu
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From Overlooked to Unveiled: A Rare Case of Focal Jejunal Lymphangiectasia Presenting as Obscure Gastrointestinal Bleeding
Gayathri S. Menon, Shrivalli Nandikur, Prasanna S. Rao, Swarna Shivakumar, Aruna R. Patil
Journal of Gastrointestinal and Abdominal Radiology.2025;[Epub] CrossRef
Sporadic small intestinal hamartomatous polyp: Causative element for obscure gastrointestinal bleeding and iron deficiency anemia: A case report
Ali Issa
International Journal of Case Reports and Images.2023; 14(1): 84. CrossRef
The role of video capsule endoscopy in the diagnosis of gastrointestinal diseases: experience of the Department of Diagnostic and Operative Endoscopy
A. A. Likutov, T. A. Vlasko, V. V. Veselov
Ambulatornaya khirurgiya = Ambulatory Surgery (Russia).2023; 20(2): 116. CrossRef
Evaluation of Low-Dose Multidetector Computed Tomography Whole Gastroenterography With Oral Administration of Contrast Agents
Yong Guo, Qing-jun Wang, Li-jing Shi, Ying-ying Hu, Wen-ping Li
Canadian Association of Radiologists Journal.2021; 72(3): 410. CrossRef
Life‐threatening gastrointestinal bleeding from a giant ileal lipoma
Amy Donovan, Sandun Abeyasundara, Hajir Nabi
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Review on the Applications of Deep Learning in the Analysis of Gastrointestinal Endoscopy Images
Wenju Du, Nini Rao, Dingyun Liu, Hongxiu Jiang, Chengsi Luo, Zhengwen Li, Tao Gan, Bing Zeng
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Preoperative detection and localization of small bowel hemangioma: Two case reports
Nobuhisa Takase, Keisuke Fukui, Takafumi Tani, Tohru Nishimura, Tomohiro Tanaka, Naoki Harada, Kimihiko Ueno, Manabu Takamatsu, Akihiko Nishizawa, Akiharu Okamura, Kunihiko Kaneda
World Journal of Gastroenterology.2017; 23(20): 3752. CrossRef

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Case Reports

Single Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography in Patients Who Underwent a Gastrectomy with Roux-en-Y Anastomosis: Six Cases from a Single Center: Jae Seung Soh, Dong-Hoon Yang, Sang Soo Lee, Seohyun Lee, Jungho Bae, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang; Clin Endosc 2015;48(5):452-457. Published online September 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.5.452

Abstract PDF PubReader ePub

Patients with altered anatomy such as a Roux-en-Y anastomosis often present with various pancreaticobiliary problems requiring therapeutic intervention. However, a conventional endoscopic approach to the papilla is very difficult owing to the long afferent limb and acute angle of a Roux-en-Y anastomosis. Balloon-assisted enteroscopy can be used for endoscopic retrograde cholangiopancreatography (ERCP) in patients with altered anatomy. We experienced six cases of Roux-en-Y anastomosis with biliary problems, and attempted ERCP using single balloon enteroscopy (SBE). SBE insertion followed by replacement with a conventional endoscope was attempted in five of six patients. The papilla was successfully approached using SBE in all cases. However, therapeutic intervention was completed in only three cases because of poor maneuverability caused by postoperative adhesion. We conclude that in patients with Roux-en-Y anastomosis, the ampulla can be readily accessed with SBE, but longer dedicated accessories are necessary to improve this therapeutic intervention.

Citations

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Single Balloon Enteroscopy-Guided Endoscopic Retrograde Cholangiopancreatography in Surgically Altered Anatomy: Long vs. Short Type
Chang-Hwan Park
The Korean Journal of Pancreas and Biliary Tract.2021; 26(3): 181. CrossRef
Direct Insertion of a Short-Type Single-Balloon Enteroscope and Using a Stent Retriever to Treat Difficult Bile Duct Stones in Surgically Altered Anatomy
Takashi Sasaki, Naoki Sasahira
Clinical Endoscopy.2021; 54(6): 937. CrossRef
Single-balloon enteroscopy-assisted ERCP in patients with Roux-en-Y anatomy and choledocholithiasis: do technical improvements mean better outcomes?
Jesús Espinel Díez, María Eugenia Pinedo Ramos
Revista Española de Enfermedades Digestivas.2020;[Epub] CrossRef
Application of single balloon enteroscopy-assisted therapeutic endoscopic retrograde cholangiopancreatography in patients after bilioenteric Roux-en-Y anastomosis: Experience of multi-disciplinary collaboration
Wen-Guang Wu, Lu-Cui Qin, Xiao-Ling Song, Ming-Ning Zhao, Wen-Jie Zhang, Jun Gu, Hao Weng, Ying-Bin Liu, Yi Zhang, Chun-Ying Qu, Lei-Ming Xu, Xue-Feng Wang
World Journal of Gastroenterology.2019; 25(36): 5505. CrossRef
Comparison between Enteroscopy-Based and Laparoscopy-Assisted ERCP for Accessing the Biliary Tree in Patients with Roux-en-Y Gastric Bypass: Systematic Review and Meta-analysis
Alberto Machado da Ponte-Neto, Wanderley M. Bernardo, Lara M. de A. Coutinho, Iatagan Rocha Josino, Vitor Ottoboni Brunaldi, Diogo T. H. Moura, Paulo Sakai, Rogério Kuga, Eduardo G. H. de Moura
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Impact of a Newly Developed Short Double-Balloon Enteroscope on Stent Placement in Patients with Surgically Altered Anatomies
Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada
Gut and Liver.2017; 11(2): 306. CrossRef

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Successful Removal of a Screw Nail in the Jejunum Using Double-Balloon Enteroscopy: Dong Ju Kim, Myoung Ki Sim, Sang Wook Lee, Tae Hee Lee; Clin Endosc 2015;48(5):444-446. Published online September 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.5.444

Abstract PDF PubReader ePub

The vast majority of foreign bodies (FBs) that enter the stomach pass through the gastrointestinal tract spontaneously. When the FB enters the small bowel-beyond the reach of conventional endoscopy-daily radiographs are needed to ensure its safe passage. However, endoscopic intervention is an appropriate management strategy for a sharp-pointed FB, because sharp FBs have a higher risk of intestinal perforation. We describe here a case in which a 1.5-cm, sharp-pointed screw nail in the proximal jejunum was removed successfully by double-balloon enteroscopy from a 19-year-old-male with autism. This case adds to the growing body of evidence demonstrating the value of therapeutic double-balloon enteroscopy in the field of FB ingestion

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Balloon-Assisted Enteroscopy for Retrieval of Small Intestinal Foreign Bodies: A KASID Multicenter Study
Jeongseok Kim, Beom Jae Lee, Nam Seok Ham, Eun Hye Oh, Kee Don Choi, Byong Duk Ye, Jeong-Sik Byeon, Chang Soo Eun, Jin Su Kim, Dong-Hoon Yang
Gastroenterology Research and Practice.2020; 2020: 1. CrossRef
Foreign Body Penetration through Jejunal Loops Causing Renal Artery Thrombosis and Renal Infarct
Najib Nassani, Elie El-Charabaty, Patricia Nasr, Iskandar Barakat, Sherif Andrawes
ACG Case Reports Journal.2017; 4(1): e12. CrossRef

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Original Article

Efficacy and Safety of Endoscopic Papillary Balloon Dilation Using Cap-Fitted Forward-Viewing Endoscope in Patients Who Underwent Billroth II Gastrectomy: Jong Soon Jang, Seungho Lee, Hee Seung Lee, Myeong Ho Yeon, Joung-Ho Han, Soon Man Yoon, Hee Bok Chae, Sei Jin Youn, Seon Mee Park; Clin Endosc 2015;48(5):421-427. Published online September 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.5.421

Abstract PDF PubReader ePub

Background/Aims

Endoscopic exploration of the common bile duct (CBD) is difficult and dangerous in patients with Billroth II gastrectomy (B-II). Endoscopic papillary balloon dilation (EPBD) via a cap-fitted forward-viewing endoscope has been reported to be an effective and safe procedure. We analyzed the technical success and complications of EPBD in patients who underwent B-II.

Methods

Thirty-six consecutive patients with B-II were enrolled from among 2,378 patients who had undergone endoscopic retrograde cholangiopancreatography in a single institute in the last 4 years. The EPBD procedure was carried out using a cap-fitted forward-viewing endoscope with 8-mm balloon catheters for 60 seconds. We analyzed the rates of CBD exploration, technical success, and complications.

Results

Afferent loop intubation was performed in all patients and selective cannulation of the bile duct was performed in 32 patients (88.9%). Complications such as transient hypoxia were observed in two patients (5.6%) and perforation, in three patients (9.7%). The perforation sites were ductal injury in two patients and one patient showed retroperitoneal air alone without symptoms. Three patients manifested different clinical courses of severe acute pancreatitis and peritonitis, transient abdominal pain, and retroperitoneal air alone. The condition of one patient improved with surgery and that of the other two patients, with conservative management.

Conclusions

Patients with perforation during EPBD in B-II showed different clinical courses. Tailored treatment strategies are necessary for improving the clinical outcomes.

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Rabbinu Rangga Pribadi, Abdul Aziz Rani, Murdani Abdullah
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Endoscopic retrograde cholangiopancreatography in Billroth II gastrectomy patients: Outcomes and potential factors affecting technical failure
Jia-Su Li, Duo-Wu Zou, Zhen-Dong Jin, Jie Chen, Xin-Gang Shi, Zhao-Shen Li, Feng Liu
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Murad Aburajab, Kulwinder Dua
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Tae Young Park, Chang Seok Bang, Sang Hyeon Choi, Young Joo Yang, Suk Pyo Shin, Ki Tae Suk, Gwang Ho Baik, Dong Joon Kim, Jai Hoon Yoon
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Review

Should Capsule Endoscopy Be the First Test for Every Obscure Gastrointestinal Bleeding?: Chung Hyun Tae, Ki-Nam Shim; Clin Endosc 2014;47(5):409-414. Published online September 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.5.409

Abstract PDF PubReader ePub

Obscure gastrointestinal bleeding (OGIB) refers to gastrointestinal (GI) bleeding of unclear origin that persists or recurs after negative findings on esophagogastroduodenoscopy and colonoscopy. OGIB accounts for approximately 5% of all types of GI bleeding. More than 80% of OGIB cases originate in the small bowel. The ability to detect OGIB in the small bowel has significantly advanced and been revolutionized since the introduction of the capsule endoscopy and double-balloon enteroscopy techniques in 2000 and 2001, respectively. With these new methods for small-bowel evaluation, new guidelines have been proposed for the diagnosis and management of OGIB. However, some issues remain unsolved. The purpose of this article is to review the various modalities used for evaluating OGIB, including capsule endoscopy and double-balloon enteroscopy, and to help guide clinicians in their decisions on which modality will be the most effective.

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Clinical features of obscure gastrointestinal bleeding undergoing capsule endoscopy: A retrospective cohort study
Yuga Komaki, Shuji Kanmura, Kazuki Yutsudo, Kosuke Kuwazuru, Fukiko Komaki, Akihito Tanaka, Hidehito Maeda, Shiho Arima, Shiroh Tanoue, Fumisato Sasaki, Shinichi Hashimoto, Masahisa Horiuchi, Akio Ido, Gopal Krishna Dhali
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Revista de Gastroenterología de México.2018; 83(1): 31. CrossRef
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Revista de Gastroenterología de México (English Edition).2018; 83(1): 31. CrossRef
Double-Balloon Endoscopy in Overt and Occult Small Bowel Bleeding: Results, Complications, and Correlation with Prior Videocapsule Endoscopy in a Tertiary Referral Center
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Different roles of capsule endoscopy and double-balloon enteroscopy in obscure small intestinal diseases
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World Journal of Gastroenterology.2015; 21(23): 7297. CrossRef
A jejunal GIST presenting with obscure gastrointestinal bleeding and small bowel obstruction secondary to intussusception
Peter Sadeghi, Sandro Lanzon-Miller
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Case Report

Small Bowel Stent-in-Stent Placement for Malignant Small Bowel Obstruction Using a Balloon-Assisted Overtube Technique: Daniel Popa, Jayapal Ramesh, Shajan Peter, C. Mel Wilcox, Klaus Mönkemüller; Clin Endosc 2014;47(1):108-111. Published online January 24, 2014; DOI: https://doi.org/10.5946/ce.2014.47.1.108

Abstract PDF PubReader ePub

Self-expanding metal stents are a useful therapy to palliate malignant and benign luminal gastrointestinal obstruction. Self-expanding metal stents has been widely reported for colonic, esophageal, and gastric obstruction. However, endoscopic delivery and placement to the small bowel is more challenging and difficult. This case illustrates the usefulness and technical advantages of the balloon-overtube and enteroscopy technique for the palliative treatment of neoplastic stenosis affecting the small intestine.

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Original Article

Late Complications and Stone Recurrence Rates after Bile Duct Stone Removal by Endoscopic Sphincterotomy and Large Balloon Dilation are Similar to Those after Endoscopic Sphincterotomy Alone: Ka Young Kim, Jimin Han, Ho Gak Kim, Byeong Suk Kim, Jin Tae Jung, Joong Goo Kwon, Eun Young Kim, Chang Hyeong Lee; Clin Endosc 2013;46(6):637-642. Published online November 19, 2013; DOI: https://doi.org/10.5946/ce.2013.46.6.637

Abstract PDF PubReader ePub

Background/Aims

Between endoscopic sphincterotomy (ES) alone and combined endoscopic sphincterotomy and large balloon dilation (ES-LBD) groups, efficacy and long-term complications, difference in biliary stone recurrence rate, and risk factors of stone recurrence were compared.

Methods

Medical records of 222 patients who underwent ERCP for biliary stone removal were retrospectively reviewed. Patients with dilated CBD ≥11 mm and follow-up longer than 6 months were included.

Results

There were 101 patients in ES-LBD group and 121 patients in ES group. Mean follow-up duration was 25.0 (6-48) months and 13.0 (6-43) months, respectively (p=0.001). There was no difference in number of ERCP sessions, brown pigment stones, angle between mid and distal common bile duct (CBD angle) <135°, and lithotripsy rate. Complete retrieval success rate was excellent in both groups (100% vs. 99%). Early complication rate of ES-LBD and ES alone group was 4 and 4.1%, respectively (p=1.000). One patient in ES-LBD group died from delayed bleeding. Late complication rate was 5.9 and 3.3%, respectively (p=1.000). Stone recurrence rate was 6.9% and 5.8%, respectively (p=0.984). The only Independent risk factor of stone recurrence was presence of periampullary diverticulum.

Conclusions

Late complication and stone recurrence rates were similar between ES-LBD and ES alone groups.

Citations

Citations to this article as recorded by

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