Diagnostic efficacy of double-balloon enteroscopy in patients with suspected isolated small bowel Crohn’s disease

Abstract

Background: Owing to the development of double-balloon enteroscopy (DBE) and video capsule endoscopy (VCE) in recent years, direct visualization of the entire small intestinal mucosa has become possible. Because of the nonspecific symptoms and the anatomic location of the small bowel, diagnosis of isolated small bowel Crohn's disease (CD) remains a challenge. The aim of this research was to explore the value of DBE for isolated small bowel CD in situations where routine tests cannot confirm the diagnosis. Methods: This study included patients with suspected isolated small bowel CD who were hospitalized in Shengjing Hospital from April 2014 to June 2018. We included patients presenting with chronic diarrhea, abdominal pain, abdominal mass, perianal lesions, and systemic symptoms including weight loss, fever, and anemia after excluding infection factors. Patients with purely colonic CD were excluded from this cohort. Patients with suspected isolated small bowel CD underwent DBE. Results: In 16/18 patients, pathological findings were detected by DBE. In 12 of the cases, small bowel CD was confirmed. The remaining four patients were diagnosed with small bowel inflammation, duodenal carcinoma, ileum inflammation and small bowel ulcers. However, the diagnosis of CD was confirmed in 14/18 (78%) patients by taking into account the clinical presentation, endoscopic and histological results as well as the experimental treatment. DBE assisted in the diagnosis in 86% (12/14) of the patients. Conclusions: In the diagnosis of small bowel CD, DBE is a helpful tool. Before assessment with DBE, clinical features, colonoscopy, and CT were used to initially assess the intestine. According to the lesions indicated by CT, we chose the most appropriate endoscope insertion route, and combined the endoscopic characteristics and pathological results of DBE to confirm the diagnosis.

The role of small-bowel endoscopy in inflammatory bowel disease: an updated review on the state-of-the-art in 2021

“…The efficacy and DY of DAE have been addressed through several studies [ 28 , 111 , 114 - 122 ]. Since it was the first form of DAE to be introduced into clinical practice, most of the evidence relates to DBE [ 12 , 117 , 118 , 120 - 122 ].…”

“…The efficacy and DY of DAE have been addressed through several studies [ 28 , 111 , 114 - 122 ]. Since it was the first form of DAE to be introduced into clinical practice, most of the evidence relates to DBE [ 12 , 117 , 118 , 120 - 122 ]. Comparisons between DBE and SBE enteroscopy have varied and interchangeable results regarding DY, depth of insertion and adverse events, while SE appeared to have the advantage of a shorter SB insertion time [ 123 - 126 ].…”

“…Biopsy sampling during DAE helped to establish a diagnosis of CD in up to 40% of cases [ 117 ]. DBE facilitated a final diagnosis of SB CD in 67% of cases (12/18) with histopathological confirmation, when patient selection followed radiological and SBCE investigation [ 122 ]. A larger retrospective cohort of 122 DBE procedures in 100 patients reported endoscopic findings indicative of CD in 60% of cases, even though histopathological confirmation was significantly lower (38%) [ 118 ].…”

The mutually complementary role of magnetic resonance enterography and conventional enteroclysis in patients with complicated and/or advanced stage of Crohn’s disease

“…Crohn's disease (CD) is a chronic infl ammatory disease of the gastrointestinal tract, characterized by luminal, transmural, and mesenteric involvement, mainly at the terminal ileum (1). Although conventional enteroclysis (CE) used to be the cornerstone for evaluating the small intestine in CD in the previous decades, the new techniques like capsule endoscopy and double-balloon enteroscopy have allowed new ways of assessing the small bowel (2)(3)(4). Nevertheless, radiological methods are still important for both initial diagnosis and assessment of complications.…”

Diagnosis and therapy using double-balloon endoscopy for small bowel disease: experience from a Chinese tertiary hospital

“…However, these studies have mainly focused on the efficacy of DBE in patients with different indications, such as suspected small bowel bleeding (SSBB), Crohn’s disease (CD), and similar conditions. 6 – 13 Few reports in China have focused on SBD detection by DBE in patients of different ages. 14 , 15 …”