What is the learning curve associated with double-balloon enteroscopy? Technical details and early experience in 6 U.S. tertiary care centers
Autor: | Gary Chen, Ahmad Kamal, Ann Chen, Simon K. Lo, Carol E. Semrad, Kenneth F. Binmoeller, Andrew S. Ross, Lauren B. Gerson, Richard A. Kozarek, Jonathan A. Leighton, Edwyn M. Harrison, Drew B. Schembre, Irving Waxman, Shahab Mehdizadeh |
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Rok vydání: | 2006 |
Předmět: |
Adult
Male Enteroscopy medicine.medical_specialty Adolescent Gastrointestinal Diseases medicine.medical_treatment Perforation (oil well) Endoscopy Gastrointestinal Catheterization law.invention Capsule endoscopy law Double-balloon enteroscopy Humans Medicine Intubation Radiology Nuclear Medicine and imaging Prospective Studies Prospective cohort study Intubation Gastrointestinal Aged Aged 80 and over medicine.diagnostic_test business.industry Gastroenterology Endoscopy Single-Balloon Enteroscopy Middle Aged United States Surgery Research Design Fluoroscopy Female business |
Zdroj: | Gastrointestinal Endoscopy. 64:740-750 |
ISSN: | 0016-5107 |
Popis: | Background Performance parameters for double-balloon enteroscopy (DBE) have not been described. Objective To determine the learning curve for DBE. Design Prospective cohort study. Setting Six U.S. tertiary centers. Patients A total of 188 subjects undergoing 237 DBE procedures; 130 (69%) with obscure GI bleeding. Interventions Performance parameters from each center's initial 10 cases were compared to the subsequent examinations. Main Outcome Measurements Exam duration, depth of insertion, and findings on DBE examination. Results DBE was introduced by mouth in 149 (63%) cases, by rectum in 77 (33%) cases, and through a stoma in 6 (2.5%) patients. The mean (±SD) duration was 109.1 ± 44.6 minutes for the first 10 cases and 92.4 ± 37.6 minutes for subsequent cases ( P = .005) but did not change for rectal DBE procedures. There was no change in mean depth of insertion, but the mean fluoroscopy time declined significantly ( P = .025). Diagnostic or therapeutic maneuvers were performed in 64% of cases; DBE led to a diagnosis in 81 (43%) patients. A total of 78% of patients had prior capsule endoscopy (CE) with significant agreement between DBE and CE (κ = 0.74). One perforation occurred (0.4%). Per-rectal cases failed to reach the small bowel in 24 (31%) cases. Limitations All patients did not undergo initial CE. The therapeutic DBE scope was not available for the initial 8 months of the study. Conclusions There was a significant decline in overall procedural time and fluoroscopy time after the initial 10 DBE cases. There was no improvement in performance parameters when DBE was performed via the rectal approach despite increased, but limited, operator experience. |
Databáze: | OpenAIRE |
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