The use of double-balloon enteroscopy in retrieving mucosal biopsies from the entire human gastrointestinal tract

Abstract

Objective. The aim of this explorative study was to evaluate double-balloon enteroscopy (DBE) as a new tool for collecting mucosal biopsies from well-defined parts of the entire small and large bowel in patients with type 2 diabetes and in matched healthy subjects. Material and methods. Twelve subjects with type 2 diabetes and 12 body mass index and age-matched healthy subjects underwent anterograde and retrograde DBE under nurse-administered propofol sedation on two separate days. We attempted to collect two mucosal biopsies from every 30 cm from pylorus to rectum. Results. A mean of 21 biopsy sites were sampled in the diabetic group versus 25 in the healthy group. In 4 out of 24 patients (2 [17%] from each group) sampling from the entire gastrointestinal system was possible. Mean depth of maximal insertion (anterograde) was 478 ± 32 cm in patients with type 2 diabetes versus 465 ± 44 cm in healthy subjects (p = 0.81) and with retrograde access 230 ± 36 cm (type 2 diabetes) versus 207 ± 26 cm (healthy subjects). Conclusions. DBE is a minimally invasive way of collecting fresh biopsies from the entire gastrointestinal tract and, thus provides research and clinical communities with a new possibility to access hitherto unexplored human anatomy and physiology.

Key Words::

• biopsy
• double-balloon enteroscopy
• gastrointestinal tract
• methodological study
• type 2 diabetes mellitus

Acknowledgments

Special thanks to the study subjects who volunteered for this extensive study and to Anne Hammering, nurse anesthetist at Gentofte Hospital. Nicolai Alexander Rhee planned the study, assisted the enteroscopic procedures and authored the first draft of the manuscript. Peter Vilmann, Jakob Westergren Hendel and Hazem Hassan performed enteroscopic procedures and reviewed the manuscript. Jens Juul Holst reviewed the manuscript. Tina Vilsbøll participated in the planning of the study and reviewed the manuscript. Filip Krag Knop designed and planned the study and reviewed the manuscript. All authors take responsibility for the contents of the article. The study was partly supported by an unrestricted grant from the Novo Nordisk Foundation.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.