A Prospective Trial Comparing Double-Balloon Endoscopy with Barium Contrast Series and CT in Patients with Suspected Small Bowel Disease

Abstract

Background and Aims: Double-balloon endoscopy (DBE) is a novel procedure for diagnosis of small bowel pathology, but little is known about the importance of DBE compared with other imaging modalities for diagnosis of small bowel disease. The aim of this investigation was to prospectively compare DBE findings with findings of two standard conventional screening tests (small bowel follow-through [SBFT] and contrast-enhanced computed tomography [CT]) in patients with suspected small bowel disease. Subjects and Methods: One hundred ten consecutive patients (63 males, 47 females; mean age, 54.1 ± 1.7 years age, range, 9-85 years) underwent DBE, and the majority (73/110) did so for obscure gastrointestinal bleeding. Within 1 month before DBE, 91 patients underwent both SBFT and CT, 7 patients underwent only SBFT and 12 patients underwent only CT. The number of positive DBE findings was compared with the number of positive SBFT and/or CT findings. Statistical significance was calculated with McNemar's χ2 statistic. Results: SBFT findings were positive in 31 of 98 (31.6%) patients. CT findings were positive in 28 of 103 (27.2%) patients. SBFT or CT findings were positive in 36 of 110 (32.7%) patients; DBE findings were positive in 69 of 110 (62.7%) patients (p < 0.001). Some lesions (n = 32) examined in detail by DBE had been detected in previous screening tests, and others (n = 37) were detected for the first time by DBE. Previous screening tests had failed to detect 53.6% of those lesions, many of which were microscopic lesions such as angiodysplasia, erosions and small ulcers (Table 1). Conclusions: DBE appears to be particularly useful for diagnosing microscopic lesions in the mucosa; such lesions are difficult to detect by conventional screening. Table 1Findings by DBE and two standard conventional screening tests (SBFT, CT) Findings DBE SBFT, CT Angiodysplasia 7 0 Erosion 5 1 Fistula 1 1 Foreign body 1 1 Mass 22 13 Ulcer 34 16 Total 70 32 DBE: double-balloon endoscopy, SBFT: small bowel follow-through, CT: computed tomography Open table in a new tab DBE: double-balloon endoscopy, SBFT: small bowel follow-through, CT: computed tomography