A multicenter experience of through-the-scope balloon-assisted enteroscopy in surgically altered gastrointestinal anatomy

Jennifer X. Cai, David L. Diehl, Ralf Kiesslich, Andrew C. Storm, Mohamad H. El Zein, Alan H. Tieu, Arthur Hoffman, Vikesh Singh, Mouen Khashab, Patrick I. Okolo, Vivek Kumbhari

Research output: Contribution to journalArticle

Abstract

Background: Surgically altered gastrointestinal anatomy poses challenges for deep enteroscopy. Current overtube-assisted methods have long procedure times and utilize endoscopes with smaller working channels that preclude use of standard accessories. A through-the-scope balloon-assisted enteroscopy (TTS-BAE) device uses standard endoscopes with a large working channel to allow metallic and plastic stent insertion. We aim to determine the efficacy and safety of TTS-BAE in patients with altered surgical anatomy. Methods: A retrospective, multicenter study of TTS-BAE in altered anatomy patients at two USA and one German institution was performed between January 2013 and December 2014. Type of anatomy, procedure indication and duration, adverse events, and target, technical, and clinical success were recorded. Results: A total of 32 patients (mean age 54 years, Caucasian 81.6%, female 42.1%, mean BMI 25.4 kg/m2) underwent 38 TTS-BAE procedures. Thirty-two percent of cases had a prior attempt at conventional enteroscopy which failed to reach the target site. The target was successfully reached in 23 (60.5%) cases. Of the 23 cases that reached the intended target, 22 (95.7%) achieved technical success and 21 (91.3%) achieved clinical success. The median procedure time was 43 min. Target, technical, and clinical success rates for TTS-BAE-assisted ERCP (n = 31) were 58.1, 54.8 and 54.8%. Seven self-expandable metallic stents (five biliary, two jejunal) were attempted, and all successfully deployed. Adverse events occurred in 4 (10.4%) cases, including one luminal perforation. Conclusion: TTS-BAE is an alternative to overtube-assisted enteroscopy that is comparable in safety in patients with surgically altered anatomies. Technical success in the instances where the target had been reached was excellent. TTS-BAE confers an advantage over overtube-assisted enteroscopy as it can facilitate the deployment of self-expandable metallic stents in the biliary tree and deep small bowel.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalSurgical Endoscopy and Other Interventional Techniques
DOIs
StateAccepted/In press - Dec 30 2016

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Anatomy
Endoscopes
Endoscopic Retrograde Cholangiopancreatography
Biliary Tract
Patient Safety
Balloon Enteroscopy
Plastics
Multicenter Studies
Stents
Retrospective Studies
Safety
Equipment and Supplies

Keywords

  • Altered surgical anatomy
  • Enteroscopy
  • ERCP
  • Roux-en-Y gastric bypass

ASJC Scopus subject areas

  • Surgery

Cite this

A multicenter experience of through-the-scope balloon-assisted enteroscopy in surgically altered gastrointestinal anatomy. / Cai, Jennifer X.; Diehl, David L.; Kiesslich, Ralf; Storm, Andrew C.; El Zein, Mohamad H.; Tieu, Alan H.; Hoffman, Arthur; Singh, Vikesh; Khashab, Mouen; Okolo, Patrick I.; Kumbhari, Vivek.

In: Surgical Endoscopy and Other Interventional Techniques, 30.12.2016, p. 1-10.

Research output: Contribution to journalArticle

Cai, Jennifer X. ; Diehl, David L. ; Kiesslich, Ralf ; Storm, Andrew C. ; El Zein, Mohamad H. ; Tieu, Alan H. ; Hoffman, Arthur ; Singh, Vikesh ; Khashab, Mouen ; Okolo, Patrick I. ; Kumbhari, Vivek. / A multicenter experience of through-the-scope balloon-assisted enteroscopy in surgically altered gastrointestinal anatomy. In: Surgical Endoscopy and Other Interventional Techniques. 2016 ; pp. 1-10.
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abstract = "Background: Surgically altered gastrointestinal anatomy poses challenges for deep enteroscopy. Current overtube-assisted methods have long procedure times and utilize endoscopes with smaller working channels that preclude use of standard accessories. A through-the-scope balloon-assisted enteroscopy (TTS-BAE) device uses standard endoscopes with a large working channel to allow metallic and plastic stent insertion. We aim to determine the efficacy and safety of TTS-BAE in patients with altered surgical anatomy. Methods: A retrospective, multicenter study of TTS-BAE in altered anatomy patients at two USA and one German institution was performed between January 2013 and December 2014. Type of anatomy, procedure indication and duration, adverse events, and target, technical, and clinical success were recorded. Results: A total of 32 patients (mean age 54 years, Caucasian 81.6{\%}, female 42.1{\%}, mean BMI 25.4 kg/m2) underwent 38 TTS-BAE procedures. Thirty-two percent of cases had a prior attempt at conventional enteroscopy which failed to reach the target site. The target was successfully reached in 23 (60.5{\%}) cases. Of the 23 cases that reached the intended target, 22 (95.7{\%}) achieved technical success and 21 (91.3{\%}) achieved clinical success. The median procedure time was 43 min. Target, technical, and clinical success rates for TTS-BAE-assisted ERCP (n = 31) were 58.1, 54.8 and 54.8{\%}. Seven self-expandable metallic stents (five biliary, two jejunal) were attempted, and all successfully deployed. Adverse events occurred in 4 (10.4{\%}) cases, including one luminal perforation. Conclusion: TTS-BAE is an alternative to overtube-assisted enteroscopy that is comparable in safety in patients with surgically altered anatomies. Technical success in the instances where the target had been reached was excellent. TTS-BAE confers an advantage over overtube-assisted enteroscopy as it can facilitate the deployment of self-expandable metallic stents in the biliary tree and deep small bowel.",
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AU - Cai, Jennifer X.

AU - Diehl, David L.

AU - Kiesslich, Ralf

AU - Storm, Andrew C.

AU - El Zein, Mohamad H.

AU - Tieu, Alan H.

AU - Hoffman, Arthur

AU - Singh, Vikesh

AU - Khashab, Mouen

AU - Okolo, Patrick I.

AU - Kumbhari, Vivek

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N2 - Background: Surgically altered gastrointestinal anatomy poses challenges for deep enteroscopy. Current overtube-assisted methods have long procedure times and utilize endoscopes with smaller working channels that preclude use of standard accessories. A through-the-scope balloon-assisted enteroscopy (TTS-BAE) device uses standard endoscopes with a large working channel to allow metallic and plastic stent insertion. We aim to determine the efficacy and safety of TTS-BAE in patients with altered surgical anatomy. Methods: A retrospective, multicenter study of TTS-BAE in altered anatomy patients at two USA and one German institution was performed between January 2013 and December 2014. Type of anatomy, procedure indication and duration, adverse events, and target, technical, and clinical success were recorded. Results: A total of 32 patients (mean age 54 years, Caucasian 81.6%, female 42.1%, mean BMI 25.4 kg/m2) underwent 38 TTS-BAE procedures. Thirty-two percent of cases had a prior attempt at conventional enteroscopy which failed to reach the target site. The target was successfully reached in 23 (60.5%) cases. Of the 23 cases that reached the intended target, 22 (95.7%) achieved technical success and 21 (91.3%) achieved clinical success. The median procedure time was 43 min. Target, technical, and clinical success rates for TTS-BAE-assisted ERCP (n = 31) were 58.1, 54.8 and 54.8%. Seven self-expandable metallic stents (five biliary, two jejunal) were attempted, and all successfully deployed. Adverse events occurred in 4 (10.4%) cases, including one luminal perforation. Conclusion: TTS-BAE is an alternative to overtube-assisted enteroscopy that is comparable in safety in patients with surgically altered anatomies. Technical success in the instances where the target had been reached was excellent. TTS-BAE confers an advantage over overtube-assisted enteroscopy as it can facilitate the deployment of self-expandable metallic stents in the biliary tree and deep small bowel.

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