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Double Balloon Enteroscopy Is a Safe and Effective Technique for Retrieval of Entrapped Foreign Body in the Small Bowel for Greater Than 100 Days
Wei-Chung Chen*1, Michael J. Bartel1, John Stauffer2, Mark E. Stark1, Frank Lukens1
1Gastroenterology, Mayo Clinic Florida, Jacksonville, FL; 2General Surgery, Mayo Clinic Florida, Jacksonville, FL
Background: Double Balloon Enteroscopy (DBE) is a surgery sparing procedure to remove ingested foreign bodies that get lodged in the small bowel. For objects that remain in the small bowel that do not spontaneously pass though the digestive system, the duration that the entrapped object can remain safely in the small bowel is unknown.
Aim: To evaluate the safety and efficacy of DBE in the removal of entrapped small bowel foreign objects and to assess the duration that these objects can remain in the small bowel before intervention.
Methods: 1735 patients underwent 2253 DBE between 2/2009 and 9/2014 at a single tertiary center of which 29 patients underwent 25 upper DBE and 18 lower DBE for removal of ingested foreign bodies. Data was abstracted by retrospective chart review.
Results: 29 patients (mean age 53.1 years, Range 20.6-86.9) underwent DBE for retrieval of a pill camera (VCE) (n=15), distal migrated biliary or pancreatic stents (n=9) and accidently or in suicidal attempt ingested foreign bodies (spoon, nail, fish hook, fish weight) (n=5). All patients had signs and symptoms associated from retained small bowel objects which led the indication for foreign body removal: abdominal pain, nausea, and vomiting. Only suicidal attempt ingested foreign bodies were removed in asymptomatic patients. The overall average time of foreign body entrapment was 146 days (range 4-630). The mean entrapment time of VCE was 106 days (range 7-272). Average entrapment time for accidently ingested objects was 13 days (range 4-43). Retrieval of the foreign body was successful in 26 patients (89%) using Roth net (48%), snare (30%) or forceps (22%). 9 patients required small bowel balloon dilation prior removal of the foreign body. 3 patients (11%) (2 pill camera and 1 nail) failed retrieval of the foreign body. 1 patient with retained pill camera underwent surgery and the other VCE passed through spontaneously. 1 patient (ingested nail) who was not a surgical candidate due to frozen abdomen passed the nail spontaneously at a later point. Of 43 DBE, 1 procedure (2%) was complicated by small bowel perforation following a successful removal of the pill camera lodged at a Crohn's stricture requiring emergent surgical intervention.
Limitations: Single center, retrospective study, heterogeneous patient population.
Discussion: DBE is a safe and effective technique with success rate of 86% and low complication rate of 2% for removal of lodged foreign bodies in the small bowel for a prolonged period of time prior attempting a surgical intervention as long as the patient remains stable. This data raises also the question how long small bowel foreign body can remain entrapped in the small bowel until decision is made to remove them.
Conclusion: DBE is a reasonable option for retrieval of entrapped foreign body in the small bowel for a prolonged period of time (>100 days).
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