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Surgical Endoscopy
Published in: Surgical Endoscopy 6/2020

01-06-2020 | Laparoscopy | Dynamic Manuscript

Single incision laparoscopic assisted double balloon enteroscopy: a novel technique to manage small bowel pathology

Authors: Ioannis Stasinos, Nikolaos Kamperidis, Alberto Murino, J. T. Jenkins, Janindra Warusavitarne, Chris Fraser, Adam Humphries

Published in: Surgical Endoscopy | Issue 6/2020

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Abstract

Background and Aims

Double balloon enteroscopy (DBE) has revolutionised the diagnosis and treatment of small bowel (SB) conditions. However, deep SB insertion can be challenging in patients with a history of abdominal surgery and a two-step procedure is required when findings are not amenable to endoscopic therapy. This case series reports the development of laparoscopically assisted DBE (LA-DBE) using single incision laparoscopic surgery (SILS).

Methods

Retrospective review of LA-DBE procedures performed in a single tertiary centre over 6 years.

Results

Seventeen patients (median age: 40 years, male 41%) underwent 17 LA-DBE procedures. The approach was oral in 13 and rectal in 4. Laparoscopic approach was standard (multi-port) in the first four cases, SILS was then used in all subsequent patients (13/17). Indications for LA-DBE were previously failed standard DBE (n = 16) and need for a combined procedure (n = 1). Indications for DBE were Peutz–Jeghers syndrome (PJS) (n = 10), suspected submucosal/polypoid lesion at small bowel imaging (n = 5) and obscure gastrointestinal bleeding (OGIB) with vascular abnormalities seen at capsule endoscopy (n = 2). In 1/17 the suggested pathology on imaging was not identified. Therapy was applied in 15/17 (88%) cases. Diagnoses were PJS polyps (n = 8), neuroendocrine tumour (NET) (n = 2), PJS and NET (n = 1), transmural arteriovenous malformation (n = 1), angioectesia (n = 1), inflammatory polyp (n = 1), leiomyoma (n = 1) and Meckel’s diverticulum (n = 1). The median (range) procedure time was 147 (84–210) mins. Median (range) length of stay post-procedure was 2 (1–19) days. Three patients developed complications. The 30-day mortality rate was 0%.

Conclusions

LA-DBE is a safe, effective and minimally invasive procedure that can be applied for the management of selected patients with small bowel pathology. A SILS approach allows all therapeutic modalities to be available, including conversion to intraoperative enteroscopy (IOE), laparoscopic small bowel resection and laparotomy.
Appendix
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Metadata
Title
Single incision laparoscopic assisted double balloon enteroscopy: a novel technique to manage small bowel pathology
Authors
Ioannis Stasinos
Nikolaos Kamperidis
Alberto Murino
J. T. Jenkins
Janindra Warusavitarne
Chris Fraser
Adam Humphries
Publication date
01-06-2020
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 6/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-07446-2

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