Reply to Mönkemüller et al. and Manno et al.

 

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Reply to Mönkemüller et al. and Manno et al.

We would like to thank Drs. Manno and colleagues and Drs. Mönkemüller and colleagues for their comments on our article [1] regarding the insertion technique for single-balloon enteroscopy.

Manno et al. have analyzed the differences between our conventional technique and the alternative simultaneous technique described by Hartmann et al. [2]. Although their experience is of only 8 cases, the simultaneous method did allow a shorter mean duration of the procedure via both the oral and the anal approaches, and there was no difference between the two techniques in the mean length of small bowel visualized. We agree that the simultaneous technique seems to allow a slight reduction of procedure time. An important point is that the inflated balloon with overtube is only helpful in order to shorten the intestine. Therefore, the operator can start the insertion of the scope any time (simultaneously, during shortening, or after shortening) once the balloon is inflated. In our experience, it is easy to insert a scope after intestinal shortening when an assistant holds the overtube, while it is also no problem to push the scope and to pull back the overtube simultaneously when both scope and overtube are controlled by one person.

Mönkemüller et al. proposed ”balloon-assisted enteroscopy” (BAE) as a unifying term for both SBE and DBE. We agree to the proposal because a single-balloon technique using the DBE system has been published in the cases of difficulty in colonoscopy [3] and endoscopic retrograde cholangiopancreatography [4]. However, it seems necessary to clarify the respective merits and demerits of SBE and DBE for conventional investigation of the small bowel.

Competing interests: None

References

• 1 Tsujikawa T, Saitoh Y, Andoh A. et al . Novel single-balloon enteroscopy for diagnosis and treatment of the small intestine: preliminary experiences.  Endoscopy. 2008;  40 11-15
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• 2 Hartmann D, Eickhoff A, Tamm R. et al . Balloon-assisted enteroscopy using a single-balloon technique.  Endoscopy. 2007;  39 E276
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• 3 May A, Nachbar L, Ell C. Push-and-pull enteroscopy using a single-balloon technique for difficult colonoscopy.  Endoscopy. 2006;  38 395-398
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• 4 Mönkemüller K, Fry L C, Bellutti M. et al . ERCP using single-balloon instead of double-balloon enteroscopy in patients with Roux-en-Y anastomosis.  Endoscopy. 2008;  DOI: 10.1055/s-2007-966949
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T. Tsujikawa,MD 

Internal Medicine

Shiga University of Medical Science

Tsukinowa-cho Seta Otsu Shiga 520-2192

Japan

Fax: +81-77-5482219

Email: tujikawa@belle.shiga-med.ac.jp