Antegrade Is More Effective Than Retrograde Enteroscopy for Evaluation and Management of Suspected Small-Bowel Disease

作者：Sanaka Madhusudhan R^*; Navaneethan Udayakumar; Kosuru Bhanu; Yerneni Himabindu; Lopez Rocio; Vargo John J

来源：Clinical Gastroenterology and Hepatology, 2012, 10(8): 910-916.

DOI：10.1016/j.cgh.2012.04.020

• Balloon Enteroscopy
• Intestine
• Diagnosis
• Treatment

BACKGROUND & AIMS: Antegrade and retrograde enteroscopy are useful for evaluating the proximal and distal small bowel, respectively. We compared the diagnostic yield, therapeutic yield, and complications of antegrade and retrograde enteroscopy. METHODS: We performed a retrospective review of a prospectively maintained database of patients who underwent small-bowel enteroscopy at our institution from January 2008 to August 2009. All enteroscopies were performed using single-balloon enteroscopy (SBE), double-balloon enteroscopy (DBE), or spiral enteroscopy (SE). A total of 250 enteroscopies were performed; 182 were antegrade (91 SBE, 52 DBE, and 39 SE) and 68 were retrograde (23 SBE, 37 DBE, and 8 SE). The mean age of the patients was 61.5 +/- 15.8 years. RESULTS: The most common indication for small-bowel endoscopy was obscure gastrointestinal bleeding (n = 83). The diagnostic yield was significantly higher for antegrade than retrograde enteroscopy (63.7% vs 39.7%; P < .001). Antegrade procedures were of shorter duration than retrograde enteroscopy (44.3 +/- 22.0 vs 58.9 +/- 29.7 min; P < .001), and the mean depth of maximal insertion was significantly greater with antegrade endoscopy (231.8 +/- 122.1 vs 103.4 +/- 102.8 cm; P < .001). The therapeutic yield also was significantly higher for anterograde enteroscopy than retrograde enteroscopy (55.5% vs 44.1%; P < .001). There were no significant differences in complications. CONCLUSIONS: Antegrade enteroscopy appears to provide a higher diagnostic and therapeutic yield than retrograde enteroscopy in patients with suspected small-bowel disease.

• 出版日期2012-8