UTILITY OF DOUBLE BALLOON ENTEROSCOPY IN PATIENTS WITH SURGICALLY ALTERED BOWEL ANATOMY AFTER OBESITY SURGERY

Aims:

To evaluate the diagnostic yield, success and complications rates of double-balloon enteroscopy (DBE) in patients with surgically altered bowel anatomy after obesity surgery and GI problems necessitating endoscopic evaluation.

Methods:

Single-center, retrospective, observational, cohort study of consecutive patients with post-obesity-surgery undergoing DBE during a 40-months study period. Patients' demographics, procedure indications, findings, endoscopic interventions, and post-procedural recovery data were recorded.

Results:

A total of 390 DBE were performed at our institution during the study period. Fourty-four patients (11.4%) with post-obesity surgery were evaluated using DBE. The most common indication for DBE was obscure GI bleeding (OGIB) (n = 18), followed by DBE-ERCP (n = 15), and evaluation of and abdominal pain or weight loss with malabsorption (n = 11). The excluded stomach could be reached in 79,6% of patients. The overall diagnostic yield of DBE-ERCP was 60% (stones, n = 4, papillary stenosis, n = 3, bile leak, n = 2, bile duct stricture, n = 1). The yield of DBE for abdominal pain or malabsorption was 45% (gastric erosions n = 2, gastro-gastric fistula n = 2, celiac disease n = 1) and DBE for OGIB 83%. Of the 18 patients with OGIB, 9 had active bleeding at the time of DBE. In all but one case, the bleeding was occurring at the site of the anastomosis, whether that be hepaticojejunal, jejunojejunal, or gastrojejunal. A total of one complication (2%) was observed (small bowel perforation after application of argon plasma coagulation to the jejunojejunal anastomosis).

Conclusions:

DBE is a feasible and relatively safe technique to evaluate the small intestines, stomach and biliary tract and associated with reasonably high diagnostic and therapeutic yields in patients with surgically altered bowel anatomy in the setting of bariatric surgery.