Yokoyama Koji, Yano Tomonori, Kumagai Hideki, Mizuta Koichi, Ono Shigeru, Imagawa Tomoyuki, Yamamoto Hironori, Yamagata Takanori
*Department of Pediatrics†Department of Internal Medicine, Division of Gastroenterology‡Department of Transplant Surgery§Department of Pediatric Surgery, Jichi Medical University.
J Pediatr Gastroenterol Nutr. 2016 Jul;63(1):34-40. doi: 10.1097/MPG.0000000000001048.
The safety and efficacy of double-balloon enteroscopy (DBE) in pediatric patients has not been well documented. We aimed to evaluate the clinical efficacy and safety of DBE in children, especially those under 10.
We retrospectively analyzed our database of DBE procedures performed between September 2000 and September 2013. Procedures performed in pediatric patients (under 18) were selected from a total of 3980, including double-balloon endoscopic retrograde cholangioscopy (DBERC).
Two hundred fifty-seven DBE procedures were performed in 117 pediatric patients (median age 12.5 years). Antegrade (oral-route) DBE was performed in 166 procedures including 104 DBERC procedures (lowest body weight 13.5 kg, youngest age 3 years), and retrograde (anal-route) DBE in 91 (lowest body weight 12.0 kg, youngest age 2 years). The overall diagnostic yield for obscure gastrointestinal bleeding and abdominal pain was 58.8%. The purpose of DBERC was achieved in 76.9% of procedures. The overall complication rate in our series was 5.4% (1.9% with the DBERC cases removed); in patients under 10, it was 10.4% (7/67). No severe complications associated with enteroscope insertion and sedation were observed. Serum amylase levels tended to be elevated in patients who underwent oral-route DBE.
DBE is safe and feasible for diagnostic evaluation of small bowel disorders in pediatric patients, even those younger than 10 years. Special attention for possible complications must, however, be paid during therapeutic DBE procedures, including DBERC, especially for patients under 10.
双气囊小肠镜检查（DBE）在儿科患者中的安全性和有效性尚未得到充分记录。我们旨在评估DBE在儿童，尤其是10岁以下儿童中的临床疗效和安全性。
我们回顾性分析了2000年9月至2013年9月期间进行的DBE手术数据库。从总共3980例手术中筛选出儿科患者（18岁以下）进行的手术，包括双气囊内镜逆行胆管造影术（DBERC）。
117例儿科患者（中位年龄12.5岁）进行了257例DBE手术。顺行（经口途径）DBE进行了166例，包括104例DBERC手术（最低体重13.5kg，最小年龄3岁），逆行（经肛门途径）DBE进行了91例（最低体重12.0kg，最小年龄2岁）。不明原因胃肠道出血和腹痛的总体诊断率为58.8%。76.9%的手术达到了DBERC的目的。我们系列中的总体并发症发生率为5.4%（去除DBERC病例后为1.9%）；在10岁以下患者中，为10.4%（7/67）。未观察到与小肠镜插入和镇静相关的严重并发症。经口途径DBE患者的血清淀粉酶水平往往会升高。
DBE对于儿科患者，甚至是10岁以下的患者，用于小肠疾病的诊断评估是安全可行的。然而，在包括DBERC在内的治疗性DBE手术过程中，尤其是对于10岁以下的患者，必须特别注意可能出现的并发症。
