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Background High-frequency catheter probe US provides detailed images when the scanning plane is perpendicular to the area of interest and the latter is within the focal zone. A multibending endoscope has been developed that has two bending sections that can be deflected independently. The aim of this study was to determine whether this new endoscope enhances high-frequency catheter probe US. Methods High-frequency catheter probe US was performed with the multibending endoscope in 33 patients with upper-GI lesions. The endoscope was carefully maneuvered until the scanning plane was perpendicular to the area of interest and the target area was within the focal zone of the probe. The effects of deflecting the second bending section on the image and on the rotating elements in the probe were evaluated. Results For 28 lesions, no improvement was observed with use of both bending sections. However, for 5 lesions, the US image was improved by use of the second bending section. These lesions were located in the stomach on the lesser or greater curve. In no instance did deflection of both bending sections result in uneven rotation of the mechanical elements in the probe. Conclusions For certain lesions, US images obtained with a catheter probe can be improved by using an endoscope with a second bending section.

Background Small-bowel bleeding is difficult to treat and diagnose. The recent introduction of wireless capsule endoscopy permits examination of the entire small intestine, but this method lacks tissue sampling and therapeutic capabilities. Recently, Yamamoto et al established a double-balloon insertion method for enteroscopy that allows examination of the entire small bowel and interventional options. Objective To evaluate double-balloon enteroscopy in patients with obscure GI bleeding. Setting Single-center prospective study. Patients Thirty-one consecutive patients with obscure GI bleeding (13 females, 18 males; mean age 56.4 ± 3.2 years). Criteria for inclusion in the study were documented iron deficiency anemia (hemoglobin level 2 g/dL over ≥2 months); upper endoscopy not revealing a site/cause of blood loss; and similarly uninformative lower endoscopy including examination of the terminal ileum. Interventions Endoscopic biopsy or therapy was performed as clinically indicated. Main Outcome Measurements Diagnostic yield for patients with obscure GI bleeding and patient follow-up. Results Double-balloon enteroscopy was completed without complications in all patients. Bleeding points were identified in 23 patients (74.2%). In 21 (91.3%) of these 23 patients the cause of blood loss was identified and treated with no further bleeding at 8.5 ± 0.6 months of follow-up. Limitations Small number of patients. Conclusions These data suggest that double-balloon enteroscopy is useful for evaluation and treatment of patients with GI bleeding of obscure origin.

Diagnostic Yield of Double-Balloon Enteroscopy in Patients with Various Ulcerative Diseases of the Small Intestine: Present Status and Problems Concerning Endoscopic Diagnosis Noriaki Manabe, Shinji Tanaka, Akira Fukumoto, Yoshiaki Matsumoto, Toshiki Yamaguchi, Madoka Nakao, Yutaka Mitsuoka, Jiro Hata, Ken Haruma, Kazuaki Chayama Background and Aims: Various diseases of the small intestine are now detected by double-balloon enteroscopy (DBE), which has revolutionized endoscopy of the small intestine. One of the most common DBE findings is ulcerative lesion. The etiology of ulcerative lesions varies. It is a matter of great importance to diagnose these lesions, including etiology, accurately. The aim of this investigation was to evaluate the diagnostic yield of DBE in patients with ulcerative lesions of the small intestine. Subjects and Methods: Between August 1, 2003, and October 31, 2005, 118 patients underwent DBE, and 52 patients (30 men, 22 women; mean age, 52.8 years) in whom a total of 159 ulcerative lesions in the small intestine were detected were enrolled in this study. After detailed endoscopic observation, biopsy specimens were obtained, and double-contrast barium examination was performed as deemed necessary. Final diagnosis was made comprehensively on the basis of endoscopic findings, pathologic findings and clinical course. Results: The most common indication for DBE in these patients was gastrointestinal bleeding (n Z 31, 59.6%). There were 12 patients (23.1%) with ulcerative lesions related to tumor (Ul-tm) and 40 patients (76.9%) with ulcerative lesions related to chronic inflammation (Ul-inf). Ten patients (83.3%) with Ul-tm had lesions located in the upper small intestine; 29 patients (72.5%) with Ul-inf had lesions located in the lower small intestine. Small (3-4 mm), circular, scattered ulcerations were commonly detected endoscopically. Twelve patients showed stenotic lesions caused by Crohn’s disease (n Z 5), tuberculosis (n Z 4) and other causes (n Z 3). A definitive diagnosis was obtained by DBE in 17 patients (42.5%). A definitive diagnosis was obtained by double-contrast barium examination after DBE in 4 patients (10%) and by consideration of DBE findings and the clinical course in 8 patients (20%). Seven cases (17.5%) remained undiagnosed. Thus, most lesions of the small intestine could be diagnosed definitively from characteristic endoscopic findings. However, some ulcerative lesions, especially those related to chronic inflammation, could not be diagnosed on the basis of a single DBE examination because configurations of the lesions varied easily according to disease stage or treatment. Conclusions: Our results suggest that about half ulcerative lesions in about 50% of patients cannot be diagnosed definitively on the basis of a single endoscopic observation.