This case report describes double-balloon endoscopy (DBE) in a 3-year-old English setter with a 6-week history of intermittent small intestinal diarrhea. Standard gastroduodenoscopy and colonoscopy showed normal mucosa, so DBE was elected for a more complete examination. The double-balloon endoscope had a balloon mounted on its distal end with a working length of 200 cm, an external diameter of 8.5 mm, and a working channel diameter of 2.2 mm. A 145-cm–long flexible overtube on the endoscope had an external diameter of 12.2 mm, internal diameter of 10 mm, and a balloon at the tip. The balloons are easy to inflate and deflate from a one-touch pump system. During DBE, balloons are operated in combination, shortening the intestine as the endoscope is advanced. The small bowel is pleated over the endoscope as the balloons are inflated and deflated. In this case, both oral and anal approaches were used and the entire GI tract was evaluated. Inflammatory changes were noted in the jejunum and biopsy specimens subsequently confirmed a diagnosis of lymphocytic-plasmacytic jejunitis. Treatment with a tapering dose of prednisone along with metronidazole and a novel protein diet were initiated, with clinical remission achieved after 3 months.
Commentary: This report describes an exciting, novel, noninvasive technique that allows visualization of the lumen for all segments of the intestinal tract. Important disadvantages to consider, however, include the high cost of the instruments and the need for additional training. In addition, the procedure takes at least 2 hours, requiring an extended anesthetic time. So far, only a couple of case studies have been reported for dogs and the risks have not been completely assessed. In human medicine, this technique appears relatively safe, although hyperamylasemia apparently is a rather common condition and a few cases of postprocedure pancreatitis have been reported.—Kathrin F. Burke, Dr med vet, Diplomate ACVP (Clinical Pathology)
A case of lymphocytic-plasmacytic jejunitis diagnosed by double-balloon enteroscopy in a dog. Ayala I, Latorre R, Soria F, et al. JAAHA 47:262-267, 2011.