Diagnostic Yield of Double-Balloon Enteroscopy in Patients with Various Ulcerative Diseases of the Small Intestine: Present Status and Problems Concerning Endoscopic Diagnosis

Abstract

Diagnostic Yield of Double-Balloon Enteroscopy in Patients with Various Ulcerative Diseases of the Small Intestine: Present Status and Problems Concerning Endoscopic Diagnosis Noriaki Manabe, Shinji Tanaka, Akira Fukumoto, Yoshiaki Matsumoto, Toshiki Yamaguchi, Madoka Nakao, Yutaka Mitsuoka, Jiro Hata, Ken Haruma, Kazuaki Chayama Background and Aims: Various diseases of the small intestine are now detected by double-balloon enteroscopy (DBE), which has revolutionized endoscopy of the small intestine. One of the most common DBE findings is ulcerative lesion. The etiology of ulcerative lesions varies. It is a matter of great importance to diagnose these lesions, including etiology, accurately. The aim of this investigation was to evaluate the diagnostic yield of DBE in patients with ulcerative lesions of the small intestine. Subjects and Methods: Between August 1, 2003, and October 31, 2005, 118 patients underwent DBE, and 52 patients (30 men, 22 women; mean age, 52.8 years) in whom a total of 159 ulcerative lesions in the small intestine were detected were enrolled in this study. After detailed endoscopic observation, biopsy specimens were obtained, and double-contrast barium examination was performed as deemed necessary. Final diagnosis was made comprehensively on the basis of endoscopic findings, pathologic findings and clinical course. Results: The most common indication for DBE in these patients was gastrointestinal bleeding (n Z 31, 59.6%). There were 12 patients (23.1%) with ulcerative lesions related to tumor (Ul-tm) and 40 patients (76.9%) with ulcerative lesions related to chronic inflammation (Ul-inf). Ten patients (83.3%) with Ul-tm had lesions located in the upper small intestine; 29 patients (72.5%) with Ul-inf had lesions located in the lower small intestine. Small (3-4 mm), circular, scattered ulcerations were commonly detected endoscopically. Twelve patients showed stenotic lesions caused by Crohn’s disease (n Z 5), tuberculosis (n Z 4) and other causes (n Z 3). A definitive diagnosis was obtained by DBE in 17 patients (42.5%). A definitive diagnosis was obtained by double-contrast barium examination after DBE in 4 patients (10%) and by consideration of DBE findings and the clinical course in 8 patients (20%). Seven cases (17.5%) remained undiagnosed. Thus, most lesions of the small intestine could be diagnosed definitively from characteristic endoscopic findings. However, some ulcerative lesions, especially those related to chronic inflammation, could not be diagnosed on the basis of a single DBE examination because configurations of the lesions varied easily according to disease stage or treatment. Conclusions: Our results suggest that about half ulcerative lesions in about 50% of patients cannot be diagnosed definitively on the basis of a single endoscopic observation.