Youssef Soliman, MD, Vikas Chitnavis, MD Carilion Clinic, Roanoke, VA
Introduction: A double balloon endoscopic interventional platform (DBIP) is an over-the-scope disposable flexible soft-sheath device with dual-balloons – one just beyond the flexible end of the scope (aft balloon), and another that can be advanced or retracted a variable distance away from the tip of the scope (fore balloon) (Fig 1A). Its main intended function is to provide colonoscope stability, fine maneuvering, and traction during colorectal polypectomy interventions. We describe an “off-label” application with the DBIP used akin to single-balloon enteroscopy (SBE) to facilitate deep ileal intubation for foreign body removal.
Case Description/Methods: A 52 yo female with a PMH of schizoaffective disorder presented after swallowing a key-ring 2 weeks prior that did not pass. She had mild abdominal pain and vomiting, but no dysphagia, constipation, melena, or hematochezia. Her CBC and CMP were unremarkable. A CT abdomen/pelvis (Fig 1 B&C) revealed a foreign object in the distal ileum 30 cm from the ileocecal vale (ICV), proximal to a site of a prior anastomosis from prior ingestion requiring laparotomy and resection. The patient refused surgery and wanted endoscopy. Neither a colonoscopy nor a SBE could advance 20 cm proximal to the ICV. Then, the DBIP helped reduce the colon and allow deep retrograde ileal intubation with a cap-mounted PCF colonoscope with fluoroscopic guidance (Fig 1 D&E).
Discussion: Deep enteroscopy can be achieved with SBE or double-balloon enteroscopy (DBE). In the retrograde approach, SBE has a comparable diagnostic yield1. SBE retrograde insertion can reach 98.1 cm proximal to the ICV2. With SBE, the enteroscope has a smaller outer diameter compared to the colonoscope (9.2 vs 11.8 mm) used in our case. A smaller diameter allows for finer tip control, but is more prone to looping. Conversely, a larger diameter may have less tip control, but is less prone to looping. Our case demonstrates that the DBIP can facilitate colon reduction and deep ileal intubation with a colonoscope when SBE is unsuccessful.
References:
1. Lu Z, Qi Y, Weng J, et al. Efficacy and Safety of Single-Balloon Versus Double-Balloon Enteroscopy: A Single-Center Retrospective Analysis. Med Sci Monit. 2017;23:1933-1939. doi:10.12659/MSM.900343
2. Gao Y, Xin L, Zhang Y-T, et al. Technical and Clinical Aspects of Diagnostic Single-Balloon Enteroscopy in the First Decade of Use: A Systematic Review and Meta-Analysis. Gut Liver. Published online October 8, 2020. doi:10.5009/gnl19345
Figure: Figure 1: The double balloon endoscopic platform (DBIP) (A). Axial (B) and coronal (C) cuts of CT abdomen/pelvis demonstrating foreign object in the right lower quadrant. Fluoroscopy helped assess progress to the foreign object (D), and the object was retrieved using forceps (E).
Disclosures: Youssef Soliman indicated no relevant financial relationships. Vikas Chitnavis indicated no relevant financial relationships.
Youssef Soliman, MD, Vikas Chitnavis, MD. P1974 - Deep Retrograde Ileal Intubation and Retrieval of a Foreign Object Using a Double Balloon Endoscopic Interventional Platform, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
