Introduction: Patients with surgically altered gastrointestinal (GI) anatomy after bariatric surgery provide a unique challenge for endoscopic evaluation. Though balloon-assisted enteroscopy has greatly improved our ability to investigate this altered anatomy, there is limited data evaluating the utility, feasibility and safety of double balloon enteroscopy (DBE) in post-bariatric surgery patients. We aim to evaluate the diagnostic yield, success and complications of DBE in patients presenting for endoscopic evaluation for various GI issues.
Methods: Single-center, retrospective cohort study of patients undergoing DBE during a 5-year study period. Patients' demographics, procedure indications, findings, endoscopic interventions, and postprocedural recovery data were recorded.
Results: A total of 672 DBE were performed at our institution during the study period. 42 (6.3%) patients were identified as post-bariatric surgery including Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy and lap band. 71.4% of patients were female (n=30). RYGB was the most common bariatric surgery (n=39, 92.9%). The most common indications for DBE were GI bleeding (n=16, 38.1%) and abdominal pain (n=11, 26.2%). Etiologies for GI issue were found in 59.5% of patients (n=25). Interventions including biopsy, hemoclipping, argon plasma coagulation, epinephrine injection, balloon dilation, and jejunostomy-tube placement were done on 76.0% of patients (n=19). Complications arose in only 3 patients (7.1%) patients. One patient developed post-op hypoxia and was admitted for observation and was found to have pulmonary thromboembolism (had prior surgery). Two patients developed infections at site of percutaneous endoscopic gastrostomy site.
Conclusion: DBE is an effective and safe technique for endoscopic evaluation in patients with altered anatomy after bariatric surgery.
