Usefulness and Limitation of Double Balloon Enteroscopy in Inflammatory Small Bowel Disease

Abstract

Background and Aim: Diagnostic ability for inflammatory small bowel disease by double balloon enteroscopy (DBE) and conventional double contrast radiography (DCR) of the small intestine were compared. Subjects: From 2003 June to 2005 May we have examined 97 patients with various complaints by DBE. 44 patients with inflammatory small intestinal diseases underwent both DBE and DCR studies. The subjects of the present study were 26 patients with Crohn's disease (CD), 7 with intestinal tuberculosis, 8 with NSAIDs enteropathy and 3 with non-specific multiple ulcer of the small intestine (NMUSI, Matsumoto, J Clin Pathol 2004). Method: DCR (using per nasal tubing method, 70 percent barium, 250 ml) and DBE study (per anal approach, Fujinon-Toshiba EN-450T5 and EN-450P5/20 scope with Yamamoto's method) were made in all patients prospectively. Comparisons of diagnosability (range of insertion and/or observation, evaluation of lesion activity) of the two studies in the small intestinal lesions were made. Results: It was hard to observe intestinal lesions fully by DBE in CD and NMUSI (average insertion range from ileocecal valve was 111 cm in CD, and 50 cm in NMUSI) because these diseases had stenoses which made full insertion of DBE difficult. In contrast, it was possible to observe even subtle lesions (aphthoid or shallow ulcers) by DBE in intestinal tuberculosis and in NAIDS enteropathy because there were few stenosis in these diseases (average insertion range from ileocecal valve was 339 cm in NSAIDs enteropathy, and 269 cm in tuberculosis). Rate of cases with better diagnosability of DBE than DCR in cases with tuberculosis or NSAIDs enteropathy group was higher than that in CD or NMUSI group (p < 0.0001, Table). However, we have succeeded in dilating multiple stenoses of the small intestine in a patient with Crohn's disease. Conclusion: From theses observation, it was concluded that stenotic lesions and adhesions of the small intestine in CD or NMUSI were hazard to full study by DBE and that conventional radiography would be beneficial to study intestinal lesions in these cases. In contrast, DBE was very useful in NSAIDs enteropathy and in tuberculosis without stenosis. DBE might be useful to dilate stenotic lesion of the Crohn's ileitis.