Complete small-bowel examination by oral single-balloon enteroscopy using the water-exchange method

Large volumes of either air or carbon dioxide need to be insufflated for good visualization during enteroscopy. This leads to significant distension of the small bowel and makes further intubation technically challenging because of the formation of loops and acute angulations [1]. The rate of complete examination is only 12.4± 9.8% for single-balloon enteroscopy (SBE) [2]. It is even more difficult, if not impossible, to achieve complete small-bowel examination using only the antegrade route for SBE. A device equipped with a decompression side tube seems promising with regard to extending the intubation depth during enteroscopy by air desufflation. However, the clinical outcomes of this method are awaited [3]. Herein, we report a case in which complete examination of entire small bowel was performed using only antegrade SBE with the water-exchange method. A 65-year-old woman was admitted with recurrent hematochezia. She had no abdominal pain, distension, vomiting, or fever, and her hemoglobin level was 11.3g/dL. Neither colonoscopy nor esophagogastroduodenoscopy (EGD) revealed a bleeding source. Computed tomography of enteroclysis (CTE) revealed segmental diffuse thickening and localized stenosis of the ileum in the pelvic cavity (●" Fig.1). Oral SBE was performed with the patient under a general anesthetic. The singleballoon enteroscope was first advanced beyond the ligament of Treitz using carbon dioxide insufflation. In order to improve the intubation depth, the water-exchange method was then used, as has been previously described in colonoscopy [4]. Any residual air in the lumen was suctioned, and water at 37°C was infused through the biopsy channel using a peristaltic pump (Olympus) to obtain lumen visualization (●" Fig.2). Turbid luminal water caused by residual feces was suctioned and replaced by clean water until the small-bowel lumenwas clearly visualized again.