The Wolfson Unit for Endoscopy, St Mark's Hospital, Watford Road, Harrow, London, HA1 3UJ, UK.
Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, Hampstead, London, UK.
Surg Endosc. 2020 Jun;34(6):2773-2779. doi: 10.1007/s00464-020-07446-2. Epub 2020 Feb 18.
Double balloon enteroscopy (DBE) has revolutionised the diagnosis and treatment of small bowel (SB) conditions. However, deep SB insertion can be challenging in patients with a history of abdominal surgery and a two-step procedure is required when findings are not amenable to endoscopic therapy. This case series reports the development of laparoscopically assisted DBE (LA-DBE) using single incision laparoscopic surgery (SILS).
Retrospective review of LA-DBE procedures performed in a single tertiary centre over 6 years.
Seventeen patients (median age: 40 years, male 41%) underwent 17 LA-DBE procedures. The approach was oral in 13 and rectal in 4. Laparoscopic approach was standard (multi-port) in the first four cases, SILS was then used in all subsequent patients (13/17). Indications for LA-DBE were previously failed standard DBE (n = 16) and need for a combined procedure (n = 1). Indications for DBE were Peutz-Jeghers syndrome (PJS) (n = 10), suspected submucosal/polypoid lesion at small bowel imaging (n = 5) and obscure gastrointestinal bleeding (OGIB) with vascular abnormalities seen at capsule endoscopy (n = 2). In 1/17 the suggested pathology on imaging was not identified. Therapy was applied in 15/17 (88%) cases. Diagnoses were PJS polyps (n = 8), neuroendocrine tumour (NET) (n = 2), PJS and NET (n = 1), transmural arteriovenous malformation (n = 1), angioectesia (n = 1), inflammatory polyp (n = 1), leiomyoma (n = 1) and Meckel's diverticulum (n = 1). The median (range) procedure time was 147 (84-210) mins. Median (range) length of stay post-procedure was 2 (1-19) days. Three patients developed complications. The 30-day mortality rate was 0%.
LA-DBE is a safe, effective and minimally invasive procedure that can be applied for the management of selected patients with small bowel pathology. A SILS approach allows all therapeutic modalities to be available, including conversion to intraoperative enteroscopy (IOE), laparoscopic small bowel resection and laparotomy.
双气囊小肠镜（DBE）的出现彻底改变了小肠（SB）疾病的诊断和治疗方式。然而，对于有腹部手术史的患者，深部 SB 插入可能具有挑战性，并且当发现不适合内镜治疗时，需要进行两步治疗。本病例系列报告了使用单切口腹腔镜手术（SILS）进行的腹腔镜辅助 DBE（LA-DBE）的发展。
回顾性分析 6 年内在一家三级中心进行的 LA-DBE 手术。
17 名患者（中位年龄：40 岁，男性占 41%）接受了 17 次 LA-DBE 手术。经口入路 13 例，经肛入路 4 例。前 4 例采用标准腹腔镜（多孔）入路，随后所有患者（17 例中的 13 例）均采用 SILS 入路。LA-DBE 的适应证为先前失败的标准 DBE（n=16）和需要联合治疗（n=1）。DBE 的适应证为 Peutz-Jeghers 综合征（PJS）（n=10）、小肠影像学提示黏膜下/息肉样病变（n=5）和胶囊内镜发现不明原因胃肠道出血（OGIB）伴血管异常（n=2）。17 例中有 1 例影像学提示的病变未被发现。17 例中有 15 例（88%）进行了治疗。诊断为 PJS 息肉（n=8）、神经内分泌肿瘤（NET）（n=2）、PJS 和 NET（n=1）、壁间动静脉畸形（n=1）、血管扩张（n=1）、炎症性息肉（n=1）、平滑肌瘤（n=1）和 Meckel 憩室（n=1）。中位（范围）手术时间为 147（84-210）分钟。术后中位（范围）住院时间为 2（1-19）天。3 例患者出现并发症。30 天死亡率为 0%。
LA-DBE 是一种安全、有效、微创的治疗方法，可用于治疗有选择的小肠病变患者。SILS 方法可提供所有治疗方式，包括转换为术中肠镜（IOE）、腹腔镜小肠切除术和剖腹术。
