1. Forum Nazionale di Gastroenterologia “AIGO 2010” L’enteroscopia R. Marmo Roma, Palazzo della Cancelleria , 14 -15 Maggio 2010

2. Publications Number – Assisted Enteroscopy 2001 - 2009

3. Prospective Multicenter Trial Comparing Push-and- Pull Enteroscopy With the Single- and Double-Balloon Techniques in Patients With Small-Bowel Disorders Andrea May et al .Am J Gastroenterol 2010; 105:575–581 Double Balloon Single balloon p Complete enteroscopy ( n , % ) 33 / 50 (66 % ) 11 / 50 (22 % ) <0.0001 Therapeutic yield ( n , % ) 36 / 50 (72 % ) 24 / 50 (48 % ) <0.025

4. Prospective Multicenter Trial Comparing Push-and- Pull Enteroscopy With the Single- and Double-Balloon Techniques in Patients With Small-Bowel Disorders Andrea May et al .Am J Gastroenterol 2010; 105:575–581 Double Balloon Single balloon p Complete enteroscopy ( n , % ) 33 / 50 (66 % ) 11 / 50 (22 % ) <0.0001 Therapeutic yield ( n , % ) 36 / 50 (72 % ) 24 / 50 (48 % ) <0.025

6. Diagnostic gain CE vs DB Marmo R et al DLD sept 2007

8. MAJOR LIMITS V.C.E : ORIENTATION BIOPSY CLEANING

11. Controindication to Capsule enteroscopy Pohl J et al. Current status of DBE…Endoscopy 2008; 40: 156 -160

12. CE SHOWING ONLY BLOOD OR CLOTS IN THE LUMEN WHAT TO DO? Courtesy dr. Pennazio

13. DBE clarified the origin of bleeding in 2/3 of patients with CE showing only blood or clots in the lumen

15. Lesions of mid gastrointestinal tract and treatment Bleeding lesions Polyps, tumors Stenosis Foreign bodies Polypectomy EMR Dilation, stent Extraction Injection, thermal, mechanical therapy PEG, PEJ ERCP

17. Bleeding lesions - Angiodysplasias

20. Rebleeding-free interval after first DBE for 50 patients with OGIB N.Ohmiya et al. Gastrointest. Endosc 2007;66:S72-7.

21. DB Endoscopic treatment Occult Overt Bleeding Pennazio M. Gastrointest Endosc Clin N Am 2009

22. 59% 24% 18% Outcomes data at 30-month follow-up after DBE (n=85)

24. Marmo et al.Endoscopy 2009, 41: 587-592 Capsule Endoscopy Double Balloon Endoscopy No lesion detected 18/193 (9.3%) No lesion detected 61/193 (31.6%) Negative also on DBE 11/18 Negative also on CE 11/61 Positive findings on DBE Vascular lesion Ulcer(s) Jejunal diverticula Neoplasia 7 2 (10.51%) 2 (10.5%) 2 (10.5%) 1(5.5%) Positive findings on CE Vascular lesion Mass n eoplasia Polyp(s) Ulcer(s) Blood or clots in the lumen Other 50 13 (2.3%) 8 (13.1%) 7 (11.5%) 6 (9.8%) 12 (19.7%) 4 (7.2%)

25. Mehdizadeh GIE 2006 Kaffes GIE 2006 Marmo Endoscopy 2009 M ö nkem ü ller Endoscopy 2006 Heine Endoscopy 2006 May GIE 2005 Yamamoto CGH 2004 0% 5% 8% 20% 35% 42% 45% 86% Zhong Endoscopy 2007 56% Eenteroscopia in 2 sessioni (%) 61% Ohmiya GIE 2007 Occidente Oriente Gross GIE 2008 Total enteroscopy DB

35. Endoscopic Interventions in the Small Bowel Using Double Balloon Enteroscopy A. May et al. Am J Gastroenterol 2007;102:527–535

36. Outcome after double balloon dilatation H. Tochigi Gastrointest Endosc 2007;66:S108-12 Surgery Relapse Long term success Crohn’s disease 23 pts 2 (8.7%) 4 (17.4%) 17 (73.9%)

42. Forum Nazionale di Gastroenterologia “AIGO 2010” L’enteroscopia R. Marmo Roma, Palazzo della Cancelleria , 14 -15 Maggio 2010 Grazie dell’attenzione

44. Publications Number – Assisted Enteroscopy 2001 - 2009