Usefulness of Double-Balloon Enteroscopy As a Diagnostic and Therapeutic Tool in Crohn's Disease

Abstract

Background/Aims: The use of double-balloon enteroscopy (DBE) has advanced the diagnosis and treatment of small intestinal diseases. It is very important to evaluate the small intestinal lesions in Crohn's disease. The aim of this study was to evaluate the usefulness of DBE in the examination of the small intestine in patients with Crohn's disease. Methods: Sixty DBE examinations by the anal route were performed in 41 patients with Crohn's disease from 2003 to 2007 in our hospital. In cases where abnormal findings were observed, after inserting the end of DBE, the balloon attached to the tip of DBE was inflated, and radiographic contrast study by injection of liquid contrast medium through the channel of DBE was also performed. Results: Fifty abnormal findings, including longitudinal ulcer, erosion, cobblestone appearance, and inflammatory polyps were observed in 60 DBE examinations. Twenty-two active ulcers in the ileum were found in 36 patients with symptoms (60.1%), whereas 11 active ulcers were observed in 24 patients even in remission (45%). Additional radiographic contrast studies were performed in 50 patients who had abnormal findings. Twenty-six additional mucosal findings in the ileum beyond where DBE reached were obtained by radiographic contrast study (52.0%). These findings included longitudinal ulcer, stricture and internal fistula. DBE examinations were performed in 9 CD patients at 6 months after the resection of small intestine. Seven patients were treated with azathioprine and all patients were in clinical remission. Active ulcers were observed in three patients (33.3%) whom we started to treat with infliximab. Conclusion: DBE is useful in the evaluation of small intestinal lesions with Crohn's disease. We suggest that it is necessary to make periodic evaluations of mucosal lesions in the small intestine by DBE because active ulcers are found even in patients in the remission phase. The combination of DBE and radiographic contrast study enable the examination of a wider range of the ileum, and the identification of more critical findings, such as internal fistula and stricture, than DBE by itself. These findings were the decisive factor in determining treatments.