SBE procedure
Before SBE procedures, patients were advised to abdominal ultrasound and
CT enterography (CTE) for primary evaluation of small bowel. All the SBE
procedures were performed by experienced endoscopists using the
SIF-Q260 (Olympus, Japan) with a 200
cm working length and 2.8 mm working channel. In general, both anal and
oral SBE procedures were performed. Unless it was clear that no polyps
were present in the ileum, the anal approach was performed first because
large polyps removed via the oral route may pile up on remaining distal
polyps and cause obstruction or intussusception. Patients were advised
to fluid diet the day before SBE operation, and poly ethylene
glycol-electrolyte powder was used for intestinal cleaning. Because the
SBE procedure time was long, all examinations were carried out with
patients under general anesthesia with endotracheal intubation.
Polyps were resected during withdrawing endoscope to avoid bleeding and
perforation at the wound after polypectomy. A diathermy loop was used to
resect a polyp as one block or multi-block according to the size and
pattern of base. The polyp size was estimated according to the width of
the biopsy forceps or the diameter of the polypectomy snare. The
retrieved polyps were measured with a ruler to determine the greatest
dimension (Figure 1). Polyp resection was performed for polyps larger
than 10 mm. However, if many polyps were found, polyps of over 20 mm in
diameter were given priority for resection to prevent
intussusception[14] (Figure 2). Complete treatment was defined by
the absence of polyps≥20mm after SBE resections. The absence of residual
polyps was considered when all polyps detected at CTE examination were
removed. If all of the large polyps could not be removed in one
hospitalization, next SBE treatment was repeated within 6 months.
Usually, endoclips (ROCC-D-26-230-C, Micro-Tech (Nanjing) Co. Ltd) were
used to close the wound to prevent delayed bleeding and perforation.
Only large and/or irregularly shaped polyps were retrieved for
pathological examination. During the first intubation of SBE,
endoclips were used at the deepest
position for mark (Figure 3). Insertion depth was measured by
accumulation of net advancement of each push-and-pull maneuver as
described by Rondonotti et al [21]. Complications related to
enteroscopy such as bleeding, perforation and acute pancreatitis were
noted. Complications were classified as intraprocedural, early (within
24 hours), or delayed (2-30 days)[15]. All complications were
obtained from hospitalization records or outpatient assessment.