P007 Double Balloon Enteroscopy in Pediatric Crohn’s Disease for Decision Therapy and 10 Years Follow up

Abstract

BACKGROUND: Crohn’s disease (CD) is a chronic recurrent inflammatory disease that may affect any segment of gastrointestinal tract. In 60-70% of CD may involve the small bowel (SB) and present a diagnostic challenge to decision regarding therapy. Double Balloon Enteroscopy (DBE) is one of endoscopic modality for children that allow the diagnostic and therapeutic procedures of SB disease. Objectives: Evaluate the feasibility, validity and safety of DBE in patients of a tertiary pediatric center with CD. In addition, we analysed its impact on treatment strategies, and established other diagnoses (malignancy, stenosis) in 10 years follow up. METHODS: Between 2007-10, 20 patients (age 2-20 years) with CD diagnosis, refractory to treatment were selected to undergo SB evaluation by DBE, oral route. We used general anesthesia (children < 12 y) or deep sedation with propofol (patients >13 y). Previously all had performed radiological imaging to exclude structuring. A 10-year follow up of patients was performed. RESULTS: Among 20 patients, 90% had SB CD in jejunum or ileum, and 10% had solely lesion in SB, which was not detected by colonoscopy. The DBE findings were: Active duodenojejunal ulcers, ulcer healing and/or pseudo polyps, sub-stenosis and mucosal granularity. Mean length of SB examined was 220 cm beyond the ligament of Treitz (range 120 to 360 cm). No significant complications were related to the procedure. Currently 14 patients are in follow up, 5 children in paediatric GI clinic and the other 9 at adult GI clinic. In 10 years follow up one patient had an extra intestinal malignancy diagnosis; one had IL-10 and/or IL-10R gene mutation and one change the diagnosis to ulcerative colitis. Curiously, the proportional number of patients in therapy, particularly biologic, had decreased. CONCLUSION(S): DBE is a useful tool to make differential diagnosis in SB paediatric pathologies, especially in CD who require escalating and de-escalating treatment. DBE has a good safety profile with a low index of complications when performed in reference centers.