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Clinical Safety and Utility of Pediatric Balloon-assisted Enteroscopy

A Multicenter Prospective Study in Japan

Hagiwara, Shin-ichiro*; Kudo, Takahiro; Kakuta, Fumihiko; Inoue, Mikihiro§; Yokoyama, Koji||; Umetsu, Shuichiro; Iwama, Itaru#,**; Yodoshi, Toshifumi**; Tatsuki, Maiko††; Shimizu, Toshiaki; Nakayama, Yoshiko‡‡

Journal of Pediatric Gastroenterology and Nutrition: March 2019 - Volume 68 - Issue 3 - p 306–310
doi: 10.1097/MPG.0000000000002181
Original Articles: Gastroenterology

Objectives: The benefit of balloon-assisted enteroscopy (BAE) had been recently documented in pediatric patients, but previous reports are based on single institution experiences. We evaluated the feasibility of pediatric BAE in 8 tertiary referral hospitals throughout Japan.

Methods: This was a prospective, multi-institutional study. Patients younger than 18 years were enrolled between April 2014 and March 2017 to undergo double-balloon or single-balloon enteroscopy. Data were collected prospectively using a standardized questionnaire.

Results: We enrolled 79 pediatric patients (96 procedures, 70 boys, 26 girls; median age 12.7 years, range 1–17 years). Antegrade (oral-route) BAE was performed in 20 procedures (lowest body weight 12.9 kg, youngest age 3.7 years), and retrograde (anal-route) BAE in 76 (lowest body weight 10.8 kg, youngest age 1.6 years). Severe adverse events were associated with BAE in 2 patients: 1 with hemorrhage due to polypectomy and 1 with pancreatitis after double-balloon endoscopic retrograde cholangioscopy. No intestinal perforation was reported. Procedure duration of oral-route BAE for diagnosis was significantly longer than anal-route for diagnosis (P < 0.001). The overall diagnostic yield for rectal bleeding/positive fecal occult blood test and abdominal pain was 48%. Among 40 patients referred for diagnosis who did not undergo capsule endoscopy, diagnoses were confirmed in 17 (42.5%) patients after BAE.

Conclusions: This prospective multicenter observational study documents the efficacy of BAE in pediatric patients.

*Division of General Pediatrics, Saitama Children's Medical Center, Saitama, Saitama Prefecture

Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo

Department of General Pediatrics and Gastroenterology, Miyagi Children's Hospital, Sendai, Miyagi Prefecture

§Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie Prefecture

||Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi Prefecture

Department of Pediatric Hepatology and Gastroenterology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa Prefecture

#Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Saitama Prefecture

**Department of Pediatrics, Okinawa Chubu Hospital, Uruma, Okinawa Prefecture

††Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Gunma Prefecture

‡‡Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Nagano Prefecture, Japan.

Address correspondence and reprint requests to Shin-ichiro Hagiwara, MD, Department of Pediatric Gastroenterology, Nutrition and Endocrinology, Osaka Medical Center and Research Institute for Maternal and Child Health, Murodo-cho 840, Izumi-City, Osaka 594-1101, Japan (e-mail:

Received 29 May, 2018

Accepted 6 October, 2018

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

SI.H. and T.K. contributed equally to this work.

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,