Effect of Water Exchange Method on Single-balloon Enteroscopy
Condition: Single Balloon Enteroscopy
Study type: Interventional

Summary: 
      Enteroscopy, including double balloon enteroscopy (DBE), single balloon enteroscopy (SBE) and
      spiral enteroscopy (SE) currently, have shown good performances in small bowel diagnostics
      and seem to be useful in the clinical routine. However, enteroscopy is a time-consuming
      procedure. During common practice, large volumes of air need to be insufflated for good
      visualization. It leads to significant distention of the small bowel during the examination,
      which makes further intubation more technically challenging because of the formation of
      distended bowel loops and acute angulations and limits the maximal intubation length.
      According to the published data, the oral insertion depth of different kinds of enteroscopy
      is limited to approximately 240 cm. The total examination rate range form 18% to 86% for DBE
      and 0% to 11% for SBE.

      It is thought that the intubation depth in small bowel determines the diagnostic yield and
      the following treatment. The deeper the enteroscopy is advanced into the small bowel, the
      more lesions may be found and treated. In order to improve the intubation depth of balloon
      enteroscopy, several methods, such as carbon dioxide insufflation and decompression side
      tube-equipped device, have been tried and showed positive effects. CO2 insufflation could
      also reduce severe pain during DBE and residual gas retention after the procedure because of
      rapid absorption. However, it is not known how much CO2 insufflation can decrease the
      distention of small bowel and the formation of bowel loops.

      Recently, the use of water infusion in lieu of air insufflation has been shown to facilitate
      completion of colonoscopy, even in potentially difficult patients with prior abdominal or
      pelvic surgery. Water exchange method obviates excessive lengthening of the colon and the
      formation of acute angulation, which may cause less pain and easier intubation during scope
      insertion. Recently, water exchange method was also tried in two patients undergoing SBE via
      antegrade route in our center. Distal ileum 8cm near to ICV and the cecum was reached
      respectively (unpublished data), indicating water exchange be a useful method for deep
      intubation of SBE.

      Here a prospective, randomized, controlled trial was designed to investigate whether,
      compared with CO2 insufflation method, water exchange method could increase the intubation
      depth and diagnostic yield in patients undergoing SBE.
    


Intervention name(s): water exchange single balloon enteroscopy; CO2 insufflation single balloon enteroscopy; Procedural Requirements
Intervention type(s): Procedure; Procedure; Other
Intervention description(s): Oral enteroscopy was performed first, followed by the anal route on the same day or later. For oral route, SBE was first advanced beyond Treitz ligation with CO2 insufflation. Then the water exchange method was used for further insertion. Briefly, residual air in the lumen was suctioned, and 37°C water was infused with a peristaltic pump through the biopsy channel to obtain lumen visualization. Turbid luminal water due to residual feces was suctioned and replaced by clean water until the small bowel lumen was clearly visualized again. Thus, infused water was removed predominantly during the insertion phase. The total volume of water was not restricted. For anal route, water exchange or CO2 insufflation method was used from the beginning of insertion respectively.; Conventional enteroscopy was performed as CO2 insufflated during insertion. Oral enteroscopy was performed first, followed by the anal route on the same day or later.; SBE was advanced as deeply as possible and complete small bowel visualization was attempted. When the following conditions were met, tattooing at the deepest position with India ink was performed and the endoscope was withdrawn: no further endoscopic advancement could be achieved, detection of a significant lesion and no other lesions suspected, severe stricture, obvious sedation and SBE-related adverse events happened which required termination of further intubation.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Diagnostic