Double-Balloon Endoscopy in Crohn Disease: A Tertiary Referral Center Experience

Abstract

Background Crohn disease (CD) affects the small bowel in 80% of patients. Double balloon endoscopy (DBE) provides the potential for direct and extensive mucosal visualization with the potential for diagnostic monitoring and therapeutic intervention. This study aimed to investigate the safety and effectiveness of DBE in small-bowel CD. Methods From our DBE database, patients with CD at the time of index DBE (January 2004-January 2013) were identified. Data collection included demographics, CD phenotype (age at diagnosis, disease location, disease activity), procedural information, adverse events (perforation, pancreatitis, death), therapeutic intervention (stricture dilation), and outcome (escalation or maintenance of existing therapy, referral to surgery). Results A total of 184 DBEs were performed in patients with inflammatory bowel disease over 162 endoscopic sessions. In this cohort, 115 patients had previously diagnosed CD. A diagnosis of CD was made in 22 patients. Of those with known CD, 140 DBEs were performed in 82 patients; DBE findings led to escalation of medical therapy in 26% of patients, maintenance of therapy in 26% of patients, and surgery in 18% of patients. We considered DBE to have failed in 11% (n = 18) of patients. During 46 endoscopic sessions, in 29 patients, 103 strictures were dilated via balloon dilation. Of patients undergoing dilation with clinical follow-up, 19 of 24 (79%) patients were surgery-free during the study period. Overall, there were 2 perforations. Conclusions We found that DBE is a safe and effective procedure in patients with suspected or established CD. Furthermore, patients undergoing dilation of strictures via DBE had an 80% surgery-free rate within the follow-up period.

Intestinal strictures in Crohn’s disease: a 2021 update

“… 81 Another study reported that CD patients with SBS who underwent double-balloon endoscopy had an 80% surgery-free rate within 25 months after initial dilation. 86 Of note, the mean intervention-free period can extend to 54 months for CD patients with asymptomatic SBS who had strictures in ileocecal valve or had no elemental diets. 87 …”

“…81 Another study reported that CD patients with SBS who underwent double-balloon endoscopy had an 80% surgery-free rate within 25 months after initial dilation. 86 Of note, the mean intervention-free period can extend to 54 months for CD patients with asymptomatic SBS who had strictures in ileocecal valve or had no elemental diets. 87 Since the recurrence rate of EBD is high up to 50% during follow-up, 88 a self-expandable metal stent with antimigration and removable features may be an alternative option.…”

Intestinal stricture in Crohn's disease: A 2020 update

“…However, EBD has a poor therapeutic effect on patients with CD and prestenotic luminal dilatation, which often indicates a long‐term disease or high‐grade stenosis 81,83‐85 . In 2020, several retrospective studies indicated that EBD using balloon‐assisted enteroscopy could delay the recurrence and reduce surgical intervention in patients with CD and small bowel stricture, with a short‐term clinical efficacy of 82.3% and long‐term effective rate of 76.5%, as well as a low complication rate of 5.3% 86‐88 …”

Endoscopy in Small Bowel Crohn’s Disease

“…In fact, it is not easy to stabilize the tip of the scope and to maintain a good visual field because of the limited space available, severe angulation, motility and adhesion in the small intestine. Nevertheless, the reported technical success rate is over 85% with a perforation rate of 1% [45,46].…”