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Double BALLOON ENDOSCOPY

Explore the effectiveness, risks, and comparison of Double Balloon Endoscopy (DBE) and Capsule Endoscopy (CE) for obscure gastrointestinal bleeding. Discover possible causes, outcomes, and alternative options to diagnose and treat small intestinal bleeding.

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Double BALLOON ENDOSCOPY

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  1. Max Brinsmead MB BS PhD May 2019 Double BALLOON ENDOSCOPY

  2. Problem • 76 year old male Caucasian with significant GIT haemorrhage • No drugs/medication • Colonoscopy and Oesaphogastroduodenoscopy negative • Capsule Endoscopy (CE) GIT • What might it find? • What are the chances it will find something? • What are the other options? • Relative merits of other investigations?

  3. Possible Causes of Small Intestinal Bleeding • Angiodysplasia 50 – 60% • Inflammatory lesions, ulcers and erosions • Includes Crohn’sdisease • Association with NSAID use • More common in Asian series • Polyp (5 – 10%) • Malignancy rare • Includes AdenoCa, Carcinoid and Lymphoma • Diverticula incl. Meckels • Active bleeding without focus

  4. Etiology of obscure gastro-intestinal bleeding according to age

  5. Angiodysplasia GIT

  6. Capsule Endoscopy

  7. Capsule Endoscopy • Capsule size 26 x 11 mm • Has colour camera, battery, light source and Transmitter • Data recorder worn as a belt • Transit time 24 – 48 hours • Takes 2 images/sec for 8 hours • Will generate 50,000 images • Retention rate 0.4 – 1.4% • Crohn’s is a relative contraindication • Will diagnose a lesion in about 66%

  8. Ray’s Capsule Endoscopy

  9. “Double Balloon Something or Other” • What is it? • How successful is it likely to be? • Risks and complications? • Other options?

  10. Double Balloon Endoscopy • Introduced by Yamamoto in 2001 • Allows complete visualization, biopsy and treatment of the small bowel • https://www.youtube.com/watch?v=7LYCtyvgBek

  11. Double Balloon Endoscopy • Essentially 100% successful with no learning curve • 75% antegrade • 25% retrograde • Takes 45 – 90 min • Can biopsy or snare polyps and argon laser angiodysplasia • Best done with CO2 insufflation • Complications more common with diseased bowel e.g Crohns

  12. Meta analysis of Capsule Endoscopy (CE) vs Double Balloon Endoscopy (DBE) • 712 patients in 12 studies • Similar diagnostic yields for both when investigating obscure GIT bleeding • DBE better for diagnosing diverticula • CE better for diagnosing fresh bleeding and clots • They are complimentary modalities • And sometimes simply repeating conventional endoscopy is required

  13. Other Options for Obscure GIT Bleeding • CT and angiography • Single balloon endosocopy • Spiral endoscopy • Operative endoscopy

  14. Please leave a Note on the Welcome Page to this Website Any Questions or Comments?

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