Post written by M. Ammar Kalas, MD, from Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA.

This study aimed to assess the effect of a through-the-scope balloon attachment on depth of maximal ileal insertion (DMI) during retrograde enteroscopy. We adopted a crossover trial design in which each patient in the study had an ileoscopy performed with through-the-scope balloon-assisted enteroscopy (TTSE) and the standard colonoscope alone. The sequence was randomized and determined prior to each procedure.

The most commonly used technique for retrograde enteroscopy is with the use of balloon-assisted enteroscopy (single or double balloon) with an overtube to assist with small-bowel reduction and increased luminal surface examination. These procedures, although effective, require additional training (for the operator and endoscopy technicians) and specialized equipment. TTSE uses a catheter with a balloon at its tip that is inserted through the instrument channel of the standard colonoscope. To our knowledge, no studies have evaluated DMI between TTSE and ileoscopy using the standard colonoscope alone.

Retrograde enteroscopy with TTSE had a modest increase in DMI (13.6-37.8 cm) compared with the standard colonoscope alone. We assessed procedure effect (TTSE vs standard colonoscope) and sequence effect (TTSE first vs TTSE second) using this tandem, crossover design. No adverse events were noted with both techniques.

This study suggests that TTSE is a safe technique for on-demand retrograde enteroscopy and may help provide increased depth of ileal insertion. Further studies with larger sample sizes are needed to evaluate the diagnostic and therapeutic yield of TTSE in retrograde enteroscopy.

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