Abstract
BackgroundOwing 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.MethodsThis 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.ResultsIn 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.ConclusionsIn 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.
Highlights
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
In 30–70% of patients with Crohn’s disease (CD), the small bowel is affected, and in up to 30% of patients diagnosed with CD, only the small bowel is involved[1, 2]
The pathological changes occurring in the distal part of the ileum manifest mainly as intestinal stenosis, which occurs as the disease progresses[3, 4]
Summary
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. In 30–70% of patients with CD, the small bowel is affected, and in up to 30% of patients diagnosed with CD, only the small bowel is involved[1, 2]. It is difficult to diagnose isolated small bowel CD because of the nonspecific symptoms and anatomic location of the small bowel. Stenosis and penetration (perforation) are major complications and require surgical intervention.{Louis E, 2003 #1292;Oostenbrug LE, 2006 #1293} Some patients with a long medical history and recurrence of disease complain of obstructive symptoms in the first medical consultation, and many patients receive delayed diagnosis and treatment. Identification and treatment of CD involving the small bowel may be beneficial to these patients
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