Original articleClinical endoscopySuccess of single-balloon enteroscopy in patients with surgically altered anatomy

BackgroundSingle-balloon enteroscopy (SBE) was introduced in 2007 to diagnose and treat small-bowel disorders. No study to date has evaluated SBE in patients with surgically altered anatomy outside of ERCP.ObjectiveTo evaluate the efficacy, yield, and safety of SBE in patients with surgically altered anatomy.DesignRetrospective study.SettingTertiary-care academic medical center.PatientsAll patients with altered surgical anatomy who underwent SBE at the Medical University of South Carolina from July 2007 to September 2013.InterventionsSBE.Main Outcome MeasurementsDiagnostic yield, therapeutic yield, technical success, and adverse events.ResultsA total of 48 patients met inclusion criteria. Mean age was 56 years (77% female). Eleven patients underwent single-balloon PEG placement, 8 single-balloon ERCP, 22 non-PEG/non-ERCP anterograde SBE, and 7 retrograde SBE. Previous surgeries included Roux-en-Y gastric bypass (n = 26), small-intestine resection (n = 6), colon resection (n = 5), Whipple procedure (n = 4), choledochojejunostomy (n = 3), hepaticojejunostomy (n = 1), Billroth I (n = 1), Billroth II (n = 1), and Puestow procedure (n = 1). Procedural indications were PEG tube placement (n = 11), choledocholithiasis (n = 2), biliary stricture (n = 2), obstructive jaundice (n = 1), cholangitis (n = 1), ampullary mass (n = 1), sphincter of Oddi dysfunction (n = 1), anemia and/or bleeding (n = 15), abdominal pain (n = 9), radiologic evidence of obstruction (n = 3), and Peutz-Jeghers syndrome (n = 2). The technical success rate was 73% in single-balloon PEG placement, 88% in single-balloon ERCP, 82% in other anterograde SBEs, and 86% in retrograde SBEs. No intraprocedural or postprocedural adverse events were observed.LimitationsSingle center, retrospective study.ConclusionSBE is safe and effective in patients with surgically altered anatomy.