Sa1652 Diagnostic and Therapeutic Advantages of Carbon Dioxide Based Double-Balloon Enteroscopy for Management of Small Bowel Diseases: a 5-Year, Single-Center Experience

Diagnostic and Therapeutic Advantages of Carbon Dioxide Based Double-Balloon Enteroscopy for Management of Small Bowel Diseases: a 5-Year, Single-Center Experience Sergey Kantsevoy*, Andrew Ofosu, Marianne Bitner, Lisa Turnbough, Sanjay Jagannath, Anurag Maheshwari, Paul J. Thuluvath Institute for Digestive Health and Liver Disease, Mercy Medical Center, Baltimore, MD; Medicine, Harbor Hospital Center, Baltimore, MD Background: Development of double-balloon enteroscopy (DBE) enabled both therapeutic and diagnostic interventions in the small bowel. Aim: To compare procedural techniques, intubation depth, safety, diagnostic and therapeutic impact of carbon dioxide (CO2) and airbased DBE in patients with known or suspected GI-tract disorders Methods: We performed a retrospectively review of all consecutive DBE performed at Mercy Medical Center for the last 5 years (2008 2012). All data (procedure indications, route of procedure, average depth of insertion, procedural findings, complications, etc) were entered into Excel database and analyzed. Results: Total of 148 procedures was performed by a single operator in 124 patients (61 Males, 63 females; mean age 63.1 14.6 years, range 25-86 years.) The most common indications were suspected small bowel bleeding (n 91, 61.5%), abnormal capsule endoscopy (n 16, 10.8%) or CT imaging (n 10, 6.8%), suspected polyps (n 15, 10.1%) or Crohn’s disease (n 8, 5.4%), unclear cause of diarrhea (n 3, 2.0%), abdominal pain (n 3, 2.0%) and recurrent small bowel obstruction (n 2, 1.4%). 23 procedures were done using air insufflation and 125 of the procedures were done with CO2. Average distance travelled through the antegrade route using C02 was 12 3.2 feet,and the average distance travelled by the antegrade route using air was only5.3 0.8 feet (p 0.001). Adjusting for age, gender and indication, the depth of insertion with antegrade approach was 7 feet more in the CO2 based DBE compared to air insufflation, p 0.001. Average distance travelled through the retrograde route using C02 was 10.2 2.5 feet and the average distance travelled by the retrograde route using air was 6.5 3.5 feet (p 0.08). Adjusting for age, gender and indication, the depth of insertion with antegrade approach was 2 feet more in the CO2 based DBE compared to air insufflation, p 0.04. The overall diagnostic yield of the DBE was 65% with most pathologic lesions found being AVM (n 32), ulcers of various etiologies (n 25), polyps (n 22), lymphoid hyperplasia (n 6), ileal stenosis (n 5), chronic active ileitis (n 5), Crohn’s disease (n 3), neuro-endocrine tumor (n 1), biliary -jejunal stenosis (n 1). Conclusion: DBE is a useful, safe and well-tolerated technique with high diagnostic and therapeutic value for management of various small bowel diseases. Use of CO2 significantly improves depth of insertion during DBE comparing to air insufflation.