Yasuhiro Okada, Toru Yamazaki, Hideaki Nakajima
Toyama Prefectural Central Hospital, Toyama, Japan


Aim of the Study: To report our experience in the use of double balloon enteroscopy (DBE) among paediatric surgical patients.

Methods: Cases of all patients who underwent DBE from January 2013 to December 2017 were reviewed. This study was approved by the ethical committee of Toyama Prefectural Central Hospital (approval number: 54105).

Main Results: Eight patients (6 males), a median age of 12 years (range 5-20) and a median weight of 44 kg (range 16-62), underwent DBE; 5 for examination of inflammatory bowel disease (IBD), 2 for suspected Peutz-Jeghers syndrome (PJS) after the recurrences of ileo-ileo intussusception, and 1 for idiopathic gastrointestinal bleeding started 12 years after Kasai portenterostomy for biliary atresia (BA).
Nine DBEs (5 trans-oral, 4 trans-anal) were performed with a median examination time of 46 min (range 6-140). Contrast studies of small bowel were combined in 3 patients (1 in IBD and 2 in suspected PJS) with DBE. Wireless capsule endoscopy (WCE) was performed in BA patient prior to DBE. The youngest IBD patient and one of the suspected PJS patients who had had laparotomy for intussusception, received general anaesthesia and other procedures were performed under sedation. In IBD patients, there were no strictures requiring surgical treatments and biopsies were performed in all cases. In suspected PJS, no further polypoidal lesions were found and no further episode of intussusception had occurred after DBE. In BA patient, the longitudinal ulcer was found at near the Roux-enY anastomosis. No complications of DBE were encountered.

Conclusion: DBE is a safe and useful tool for small bowel disease in paediatric surgical patients. In our case series, we found it is more effective in conjunction with contrast study and/or WCE for optimizing diagnostic potentials. Complications due to the attempt to observe the entire small intestine by DBE alone could be avoided.