X-ray sensibility towards the origin of small intestine bleedings is relatively low, so people are always searching new imaging techniques. The use of video capsules improved the situation, but their use does not allow the execution of biopsies or therapeutical procedures. Recently, a new endoscopy technique was created (also defined “push-and-pull”) exploiting a particular tool: an enteroscopy surrounded by a Plexiglas transparent hose gliding on it: at the end of both tools, there are two balloons, which can be inflated if necessary. The balloons inflation allows to “catch” the bowel and to place it on the tool to display vast parts of the small intestine. The tool can be orally or rectally introduced in order to respectively explore the proximal or the distal part of the bowel. Two trials were performed to assess the reliability of this new tool, performed on patients in whom gastroscopy and colonscopy were not able to show the origin of gastrointestinal bleedings. In the first trial, performed in China, the double-balloon tool used in 152 patients revealed the bleeding origin in 76% of cases (most of them were angiodysplasias or small-intestine cancers); in the second trial, performed in Germany, the tool’s diagnostic capability reached 73% (vs 44% of traditional techniques). In this second trial, the endoscopy was orally introduced, reaching a 230-cm deepness. In both trials, an argon laser was used to coagulate the bleeding source, with no severe complication.
The tool seems to be very promising and its use in unsolved cases, both at a diagnostic and at a therapeutical level, is certainly desirable. But for the moment, we are still at an experimental level.
