Tagaya Nobumi, Kasama Kazunori, Inamine Susumu, Zaha Osamu, Kanke Kazunari, Fujii Youichirou, Kanehira Eiji, Hiraishi Hideyuki, Kubota Keiichi
Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan.
Obes Surg. 2007 Sep;17(9):1165-70. doi: 10.1007/s11695-007-9198-8.
Morbid obesity has become a serious health problem. We have been performing laparoscopic Roux-en-Y gastric bypass (LRYGBP) for morbid obesity since February 2002. Although LRYGBP ameliorates complications of morbid obesity, postoperative investigation of the excluded stomach is difficult. In patients with a family history of gastric cancer, resection of the bypassed stomach is sometimes added, but this requires longer operating time. There are two problems associated with LRYGBP: the high rate of gastric cancer in Japan, and how to investigate the excluded stomach.
To resolve these problems, we introduced double-balloon intestinal endoscopy. We report double-balloon endoscopy (DBE) in 4 patients.
No problems with advancing the endoscope were encountered during observation. We used an overtube to insert the scope further in order to avoid forming redundant loops in the small intestine, and two balloons to grip the intestinal wall. Although performing DBE involves a learning curve, there were no major obstacles to passage of the scope into the esophagus, small gastric pouch, lifted jejunum, the jejunojejunal anastomosis, Y-loop, duodenum and excluded stomach.
Use of the double-balloon technique makes it possible to observe the GI tract after laparoscopic LRYGBP irrespective of the length between the gastrojejunostomy and the jejunojejunostomy.
病态肥胖已成为一个严重的健康问题。自2002年2月以来，我们一直在为病态肥胖患者实施腹腔镜Roux-en-Y胃旁路手术（LRYGBP）。尽管LRYGBP可改善病态肥胖的并发症，但术后对旷置胃的检查却很困难。对于有胃癌家族史的患者，有时会加做旷置胃切除术，但这需要更长的手术时间。LRYGBP存在两个问题：日本胃癌发病率高，以及如何检查旷置胃。
为解决这些问题，我们引入了双气囊小肠镜检查。我们报告了4例患者的双气囊小肠镜检查（DBE）情况。
观察过程中未遇到内镜推进困难的问题。我们使用外套管进一步插入内镜，以避免在小肠内形成多余的肠袢，并使用两个气囊夹住肠壁。尽管实施DBE存在学习曲线，但内镜通过食管、小胃囊、提起的空肠、空肠空肠吻合口、Y形肠袢、十二指肠和旷置胃并无重大障碍。
使用双气囊技术能够观察腹腔镜LRYGBP术后的胃肠道情况，而不受胃空肠吻合口与空肠空肠吻合口之间长度的影响。
