Dilatation of Small Bowel Strictures By Double Balloon Enteroscopy: Further Results from the UK

Abstract

Introduction: Double balloon enteroscopy (DBE) facilitates endotherapy of deep SB pathology. Our preliminary prospective proof of concept analysis on DBE dilatation of Crohn's Disease (CD) SB strictures was presented to the ASGE at DDW 2008. We now report further on our prospective data of DBE stricture dilatation in an expanding cohort of patients with CD and NSAID induced SB strictures from the UK. Aims and Methods: Since introduction of DBE to our unit in 2005, data on cases of DBE SB stricture dilatation were prospectively collected for outcome, need for repeat dilatation and surgery. The DBEs were performed using the EN-450T5 scope (Fujinon, Saitama, Japan). Balloon ilatation was performed using controlled radial expansion (CRE)balloon dilators. A standardised 10cm visual analogue scale (VAS) characterised symptoms and dietary restriction before DBE stricture dilatation and at follow-up. Results: A total of 14 DBEs were done in 12 consecutive cases (mean age 46.4 ± 7.8 years). In all but 2 cases, the strictures were characterised radiologically before DBE. In 11 of the cases, the SB strictures were CD related, in 1 case they were NSAID induced. Twenty six SB stricture dilatations were performed in 10 of 12 patients. The patient with NSAID related strictures had successful dilatation of 8 strictures in one session. In another case of CD SB strictures, a retained video capsule was retrieved after dilatation of the culprit strictures. Mean stricture dilatation diameter was 14.5mm (range 12-20mm). In the 2 cases where stricture dilatation was not performed, DBE hindrance by adhesions made reaching the strictures impossible. These two cases were then managed surgically. One case of complex CD stricture dilatation was complicated by a delayed perforation. This case required a temporary jejunostomy which has since been reversed. In the other 9 cases SB stricture dilatation by DBE was an unhindered success; the symptom and dietary restriction scores improved dramatically and to date (mean follow up 19.4; range 1-40 months) none of these cases has required surgery for SB strictures. At follow-up, 2 patients required a repeat straightforward DBE dilatation (at 6.5 and 13 months respectively) due to recurrence of some of their symptoms. Although the numbers in this series are small, the clinical improvements in pre and post DBE VAS scores were large enough (means of 9.2 vs 1.7 respectively; p<0.001). Conclusion: This series adds to the growing body of published evidence that DBE SB stricture dilatation can be very effective, with the potential to help avoid the risks of surgery, small bowel resection and the associated risks of short bowel syndrome.