A recent prospective study documented the utility of double-balloon enteroscopy (DBE) in the pediatric population (JPGN 2014; 58: 204-12).

Key stats/findings:

• 113 DBE procedures were performed in 58 children with a median age of 12.7 years (range 1-18 years) during the years 2008-2012.  54 of these children had undergone wireless capsule endoscopy.
• Procedural time: 92.5 minutes
• Median estimated insertion length of SB distal to pylorus was 230 cm and proximal to ileocecal valve was 80 cm. The DBE approach (oral, anal, or both) was at the discretion of the gastroenterologist.  In cases where both approaches were used, the authors used a methylene blue “tattoo” at the most distal portion of the oral approach to help ascertain whether the entire bowel was visualized.
• Indications: polyposis syndromes (n=21), obscure GI bleeding (n=16)
• Findings: polyps (n=19), ulcers/erosions (n=8), submucosal elevations with white nodules (n=4), angioma/angiodysplasia (n=2)
• Overall diagnostic yield for SB lesions was 70.7% and for WCE 77.7%; endscopic therapy intervention was successfully used in 46.5% (27/58)
• Three complications (5.2%) were noted with uneventful recovery.  One perforation in a SB transplant patient, one had hypotension requiring fluid resuscitation, and one (who had laparascopic assistance) developed a pelvic abscess (no perforation identified).

Take-home message: DBE has developed as a useful procedure in highly selected cases.  A small number of highly qualified, procedurely-oriented pediatric gastroenterologists are likely to fill this niche.

Related blog post: Pediatric capsule endoscopy experience | gutsandgrowth