Usefulness Of Double Balloon Endoscopy Research Articles

Use of double-balloon endoscopy and an endoscopic scoring system to assess endoscopic remission in isolated small bowel Crohn's disease after treatment with infliximab.

It is unclear how clinical and endoscopic factors affect the attainment of endoscopic remission (ER) in patients with small bowel Crohn's disease (SB-CD) who are infliximab-naïve. We aimed to identify the effect of different factors on attaining ER using double-balloon endoscopy (DBE) evaluation. A single-center retrospective observational study was conducted from 1 January 2018 to 30 November 2022. Among 262 patients who were screened for isolated SB-CD by baseline DBE, 108 patients were assessed for effectiveness during maintenance infliximab therapy by a second DBE evaluation. DBE findings before and after infliximab therapy were compared. ER was defined as a simple endoscopic score for CD (SES-CD) below 3, and segmental ER as SES-CD activity of 0. Multivariate regression with calculations of odds ratios (OR) was used to determine the impact of different factors on attaining ER. In all, 41 patients (38.0%) achieved ER. An elevated C-reactive protein at week 6 was independently associated with a decreased probability of ER [OR: 0.86, 95% confidence interval (CI) = 0.75-0.98, p = 0.03]. Segmental ER of the terminal ileum, rather than the proximal ileum, was associated with a higher rate of ER (60.9% versus 38.2%, p = 0.01). High baseline SES-CD (⩾16) was unrelated to overall ER. For patients with disease in the terminal ileum, those with moderate/severe disease were less likely to attain segmental ER than those with mild disease [adjusted odds ratios (aOR): 0.27, 95% CI: 0.09-0.83, p = 0.02]. A large ulcer in the terminal ileum was associated with a lower rate of segmental ER (aOR: 0.18, 95% CI: 0.06-0.56, p = 0.01). For infliximab-naïve patients with SB-CD, the overall severity of the endoscopic score was unrelated to attainment of ER. Patients were less likely to attain segmental ER if they had greater endoscopic inflammation or larger ulcers in the terminal ileum.

Efficacy and safety of endoscopic stent placement for afferent loop obstruction using a short double-balloon endoscopy.

BackgroundAfferent loop obstruction (ALO) is a rare mechanical complication that occurs after gastrojejunostomy. Recently the use of double‐balloon endoscopy (DBE) can be useful for benign and malignant ALO.MethodsWe retrospectively identified 22 patients who underwent DBE for ALO from January 2009 to December 2020. We evaluated the efficacy and safety of short DBE treatment for ALO.ResultsShort DBE was able to reach an obstructive site in the afferent limb in all patients (100%) and was able to reach the blind end in 14 patients (64%). The technical success rate was 100%, and the clinical success rate was 95%. Procedure‐related adverse events occurred in two patients (9%). In the case of benign ALO, three of nine patients showed improvement in ALO with single stent placement. Two of nine patients improved after the replacement of the plastic stent (PS) two or three times. Four of nine patients continued with the replacement of PS. In the case of malignant ALO, the metallic stent was placed in 10 patients, and eight patients with metallic stents did not experience stent occlusion until they died. Reintervention was attempted in six patients (27%) with benign ALO but was not attempted in malignant ALO.ConclusionsTreatments for ALO using the short DBE was effective and relatively safe because the technical and clinical success rates were very high and there were relatively low complications. Consequently, short DBE could be the first‐choice treatment for both benign and malignant ALO.

Melena Secondary to Phlebectasia of the Small Bowel

Background: Phlebectasias are benign venous malformations that may rarely be found in the small intestine. They are bluish-red appearing lesions, millimeters to centimeters in diameter, thought to be congenital in nature. Though typically asymptomatic, they can manifest as minor and major overt GI bleeds. Case Report: The patient is a 69-year-old woman with a history of coronary artery disease, diabetes, pulmonary hypertension, chronic kidney disease, iron deficiency anemia, and a recent provoked DVT on Xarelto. She presented to our clinic for evaluation of her anemia. At that time she endorsed worsening of fatigue and light-headedness in addition to new onset melanotic stools. Decision was made to admit the patient and she was found to have a hemoglobin of 4.4 g/dL, down from her baseline value of 8-10 g/dL. Her anticoagulation was held and she underwent an EGD and colonoscopy which were unrevealing for source of bleeding. A capsule endoscopy was performed revealing several phlebectasisas localized around the distal duodenum and proximal jejunum. They were not actively bleeding. By the time of discharge, she had received a total of 4 units of pRBC. She was discharged on oral iron supplementation with outpatient laboratory follow up to monitor the status of her anemia.FigureFigureFigureDiscussion: Phlebectasias of the small intestine represent a rare and possibly under-recognized cause of occult and overt GI blood loss. The increasing prevalence capsule endoscopy in clinical practice in addition to an improved understanding of phlebectasias and other vascular ectasias will aid in diagnosis of GI bleeding sources. Current treatment is primarily supportive such as with iron supplementation. Other options employ the use of double-balloon endoscopy with subsequent cyanoacrylate injection or endoscopic injection sclerotherapy. More aggressive routes such as small bowel resection may also be considered in extreme or refractory cases.

Considerable Risk of Restenosis After Endoscopic Treatment for Hepaticojejunostomy Stricture After Living-Donor Liver Transplantation

BackgroundThere are few reports on the short- and long-term follow-up of endoscopic retrograde cholangiography (ERC) in adult patients with hepaticojejunostomy (HJS) stricture after living-donor liver transplantation (LDLT). MethodsNine LDLT recipients underwent ERC with the use of double-balloon endoscopy (DBE) for HJS stricture at Nagoya University Hospital. We assessed the rate of reaching biliary anastomosis, procedure success rate, procedure duration, complications, improvement in liver function test results, and biliary anastomosis patency. ResultsIn total, 19 ERC procedures with the use of DBE were performed for 9 adult LDLT recipients with HJS stricture from June 2006 to September 2014. Balloon dilation with the use of DBE was successfully performed in 5 of the 9 patients during the 1st procedure. Of the 4 patients in whom DBE-ERC failed to be completed, 3 patients underwent 2nd procedures successfully. Liver function test results were significantly improved in the successful cases. Four patients underwent 2nd DBE-ERC for stricture recurrence at a mean time of 2.3 years after the 1st successful procedure. Of those, 2 patients required 3rd procedures for stricture recurrence after the 2nd procedure. ConclusionsDBE-ERC is promising as a treatment for HJS stricture in adult LDLT recipients in the short term. However, the DBE-ERC procedure may have a considerable risk of restenosis.

Characterization of Endoscopic Findings of Small Bowel Tumors and Clinical Usefulness of Double-Balloon Endoscopy

Introduction: While 35 cases of small bowel tumor have been diagnosed since introduction of double balloon endoscopy (DBE) in our hospital, most cases of the disease were diagnosed at advanced stage with remarkable ulcerous lesion. To characterize endoscopic findings, we retrospectively analyzed endoscopic images of small bowel tumor cases diagnosed in our hospital. Methods: Based on the medical records, we retrospectively analyzed endoscopic images and patients' characteristics of 35 small bowel tumor cases diagnosed at Kyorin University hospital from 2005 to 2014. Results: In 35 cases, male-to-female ratio was 17:18 and mean age was 65.4 years. The reason for taking DBE was 21 of gastrointestinal bleeding of obscure origin (OGIB), 5 of ileus, 5 of tumorous lesions detected by other modalities, 2 of vomiting, and 2 of others. In the cases of OGIB, 15 cases were malignant tumors, and all of them were advanced stage. There was none of malignant tumor at earlier stage. Final diagnosis of 25 small bowel tumor cases were malignant tumors including 9 of GIST, 7 of adenocarcinoma, 4 of malignant lymphoma, 3 of metastatic small intestinal cancer, 2 of neuroendocrine tumor (NET). Other 10 cases were benign tumors. In the endoscopic images, submucosal tumor-like ridges with redness were observed in all 9 GIST cases including 6 cases with ulcer. All of the 7 adenocarcinoma cases were found as protruded lesions with ulcers. Irregular protruded lesions with ulcers were observed in all 4 malignant lymphoma cases. In a NET case, a protruded lesion with narrow-shaped ulcer was observed. As described above, ulcerous lesions with deep and wide range were concurrently observed in 22 of 35 small-bowel tumor cases, particularly, in malignant lymphoma, adenoma, and metastatic small-bowel tumor. About safety of DBE, perforation as complication was occurred only in a case of metastatic small bowel tumor. Conclusion: Although the majority of reason for DBE was OGIB, many cases were found at advanced stage in malignant cases. These lesions were often appeared as tumor with a wide range of ulcerous lesions. DBE is useful for pathological diagnosis of small bowel tumors, but further improvement is necessary for diagnosis of malignant tumor at earlier stage.

The Usefulness of Double-Balloon Endoscopy for Small Bowel Tumors

The Usefulness of Double-Balloon Endoscopy for Small Bowel Tumors

Melanosis Ilei

A 65-year-old woman was admitted with a 2-week history of edema of the lower extremities in 2010. Her past medical history was significant for gastrointestinal stromal tumor of the stomach, and she had a partial gastrectomy in 2005. In 2008, she was diagnosed with a local recurrence, and a total gastrectomy was performed, with subsequent daily administration of imatinib. There was no sign of tumor recurrence during a 32-month follow-up period. This patient had a long history of constipation and extensive use of laxatives containing anthraquinone. Physical examination revealed anemia and pitting edema of the lower limbs. Laboratory investigations indicated a total white blood cell count of 4570, hemoglobin of 8.8 g/dL, and hypoalbuminemia (2.6 g/dL). Liver and renal function was normal and urinalysis showed no protein. Upper endoscopy was not indicative. Colonoscopy revealed diffuse dark pigmentation throughout her colon, consistent with melanosis coli (Figure A). A colonic biopsy specimen showed pigmented macrophages in the lamina propria. Subsequent double-balloon endoscopy revealed diffuse and dark punctuate pigmentation in the ileal mucosa (Figure B). Biopsy of the affected areas revealed deposition of the dark granular pigment inside the macrophages in the villous stroma (Figure C). Iron stain was negative, indicating that the dark granular pigment was not hemosiderin. Consequently, we supposed that the patient's hypoalbuminemia was imatinib-related. After cessation of imatinib therapy, the serum albumin level rose and then stabilized at a normal level. Melanosis coli is the common condition during endoscopic evaluation. Chronic use of laxatives containing anthraquinone directly affect epithelial cells, inducing the production of lipofuscin, which results in the dark pigmentation seen in macrophages.1Walker N.I. Bennett R.E. Axelsen R.A. Melanosis coli A consequence of anthraquinone-induced apoptosis of colonic epithelial cells.Am J Pathol. 1988; 131: 465-476PubMed Google Scholar Melanosis can affect other parts of the gastrointestinal tract. Melanosis duodeni is a rare condition that has been associated with hypertension, gastrointestinal bleeding, and chronic renal failure.2Yen H.H. Chen Y.Y. Soon M.S. Pseudomelanosis duodeni: an unusual finding from upper gastrointestinal endoscopy.Clin Gastroenterol Hepatol. 2009; 7: e68Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Certain medications such as hydralazine, furosemide, and ferrous sulfate have also been implicated in this condition. Melanosis of the small intestine is an extremely rare condition, but melanosis ilei in patients given oral iron therapy has been described,3Almeida N. Figueiredo P. Lopes S. et al.Small bowel pseudomelanosis and oral iron therapy.Dig Endosc. 2009; 21: 128-130Crossref PubMed Scopus (7) Google Scholar with hemosiderin pigment present in those cases. Charcoal components, as a consequence of chronic ingestion of charcoal, also have been reported to cause melanosis of the small intestine,4Kim J. Hwang J.K. Choi W.S. et al.Pseudomelanosis ilei associated with ingestion of charcoal: case report and review of literature.Dig Endosc. 2010; 22: 56-58Crossref PubMed Scopus (10) Google Scholar but our patient had not consumed such material. Because she had a history of chronic use of laxatives, and characteristics of the pigment were identical in the ileum and colon, we suppose that long-term use of anthraquinone-containing medications could have been the major cause of pigment deposition of the ileum. Despite the benign aspects of melanosis ilei, the increasing use of double-balloon endoscopy to evaluate small intestinal diseases suggests that gastroenterologists should be aware of its existence.

Double-balloon endoscopy-diagnosed multiple small intestinal ulcers in a Churg-Strauss syndrome patient

Churg-Strauss syndrome (CSS) is a systemic vascular disorder characterized by severe bronchial asthma, hypereosinophilia, and allergic rhinitis. Small intestinal ulcers associated with CSS are a relatively rare manifestation that causes gastrointestinal bleeding. Multiple deep ulcers with an irregular shape are characteristic of small intestinal involvement of CSS. Video-capsule-endoscopy (VCE), double-balloon endoscopy (DBE) and Spirus assisted enteroscopy have been developed recently and enabled observation of the small intestine. In this case report, we have described a patient with CSS who had multiple deep ulcers in the jejunum detected by oral DBE. Since severe gastrointestinal (GI) involvement has been identified as an independent factor associated with poor outcome, the careful investigation of GI tract must be needed for CSS patients with GI symptoms. We describe the usefulness of DBE for diagnosis of small intestinal ulcers in patient with CSS.

A Case of Lymphocytic-Plasmacytic Jejunitis Diagnosed by Double-Balloon Enteroscopy in a Dog

A 3 yr old male English setter dog was presented for evaluation of a 6-wk history of intermittent diarrhea. After standard gastroduodenoscopy and colonoscopy showed normal mucosa, double-balloon endoscopy (DBE) was used via both oral and anal approaches. Gross changes consistent with inflammation in the jejunum were seen, and biopsy specimens were obtained. Histologic analysis confirmed a diagnosis of lymphocytic-plasmacytic jejunitis. Clinical remission of the disease occurred after 3 mo of therapy with prednisone, metronidazole, and a novel protein diet. Use of DBE has not been previously reported in dogs with inflammatory bowel disease, and isolated lymphocytic-plasmacytic jejunitis has not been described. The described cases of intestinal inflammatory disease diagnosed by conventional endoscopy were related to pathologic changes in the duodenum, ileum or colon, but not the jejunum. The main advantage of the DBE technique allowed examination of portions of the small intestine (jejunum) that were not commonly accessible by standard endoscopic techniques, and permitted a minimally invasive collection of biopsy samples compared with surgical biopsy. This case highlights the need to consider using DBE in animals with gastrointestinal disorders, whose symptoms are not readily explained by routine tests, conventional endoscopy, and dietary or therapeutic trials.

Small intestinal metastasis from intrahepatic cholangiocarcinoma: Report of a case

Metastasis of the small intestine that derives from a primary hepatic neoplasm is rare. We encountered a case of intrahepatic cholangiocarcinoma (ICC) with jejunal metastasis after resection of a primary lesion. A 61-year-old male patient was referred to us with a diagnosis of liver tumors. Partial hepatectomy was performed, and the pathological diagnosis was ICC. Seventeen months after surgery, the patient was found to have a mass in the jejunum and lymph node swelling by positron emission tomography-computed tomography. The jejunal tumor was preoperatively diagnosed as a metastasis of ICC from a biopsy specimen obtained by double balloon endoscopy, and the tumor was resected. The patient received systemic chemotherapy but succumbed with ICC recurrence 46 months after the primary surgery. To the best of our knowledge, this case is the first report of jejunal recurrence of ICC. In addition, this report suggests the usefulness of double balloon endoscopy to make the correct diagnosis of the jejunal tumor.

Tu1563 Usefulness of Double-Balloon Endoscopy in the Diagnosis and Treatment of Small Bowel Tumors

Small bowel tumors (SBTs) have been difficult to make early diagnosis because of the site of origin. Recently, video capsule endoscopy and double-balloon endoscopy (DBE) have made it possible to observe the whole small intestine endoscopically.

Usefulness of Double-Balloon Endoscopy in the Postoperative Gastrointestinal Tract

Background. The small intestine has been considered to be a highly difficult organ to visualize in imaging examinations due to its anatomical location compared with the stomach and the colon. In recent years, many imaging modalities have become available, such as CT enterography, MR enterography, capsule endoscopy (CE), and double-balloon endoscopy (DBE). Patients and Methods. DBE was performed in the postoperative intestines of 91 patients (128 DBE examinations) at Iwate Medical University between 2004 and 2010. There were 61 male and 30 female patients, and their mean age was 69.7 years (range: 30–80 years). Results. A total of 124 DBE examinations were performed with endoscope insertion into the reconstructed intestines. The endoscope reached the blind end in 115 of 124 examinations, (92.7%). There were 17 patients with obscure gastrointestinal bleeding in whom 30 DBE examinations were performed. The bleeding site was identified in 12 patients (70.6%). Nine patients underwent endoscopic treatment. Hemostasis was achieved in all patients. Conclusion. DBE is very useful modality for the assessment and application of endotherapy to areas of the small bowel which have been altered by surgery.

Morphometry of the canine intestine with reference to the use of double balloon endoscopy

Double balloon endoscopy (DBE) enables the diagnosis and treatment of small intestinal disease. The dog is a potential animal model for DBE training and also a candidate for the clinical application of this technique. However, the anatomy of the canine small intestine may limit the use of DBE by restricting the push-and-pull manoeuvres required for DBE. To establish what these limitations are, the length and width of different portions of the small intestine as well as the mesenteric dependences were measured in 55 dogs. Several external parameters related to body size plus the age, weight, sex and breed were recorded. Potential restriction of the progress of the enteroscope due to narrow intestinal diameter is expected in the jejunum of mid- and small size dogs.

W1624: Symptoms in Patients With Crohn's Disease Are Related to the Presence of Strictures Rather Than to That of Active Ulcers in the Small Bowel by the Examination of Double-Balloon Enteroscopy

The use of double-balloon endoscopy (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.

Roles of double-balloon endoscopy in the diagnosis and treatment of Crohn’s disease: a multicenter experience

Double-balloon endoscopy (DBE) examinations are not yet widely accepted as routine procedures for examining the small bowel of patients with Crohn's disease (CD). To evaluate the feasibility and usefulness of DBE for CD in tertiary-care hospitals. Between July 2004 and September 2008, 1444 DBE procedures were performed for 704 patients in 6 tertiary-care hospitals. Patient profile, indication, diagnosis and treatment of DBE were evaluated using a multicenter database. DBE examinations were most frequently performed in 75 patients with CD, corresponding to 10.5% of all the patients examined by DBE. Fifty patients were diagnosed with CD before DBE, while DBE was performed for the diagnosis of 25 new CD patients. Small bowel lesions were often detected even when the terminal ileum was not involved. In the 75 patients, 21 patients were asymptomatic at the time of DBE examinations. Active inflammatory lesions were detected in 51.2% of the CD patients, and were even detected in 33.3% of the asymptomatic CD patients. The treatment was altered in 53.3% of the CD patients after the DBE evaluation. No severe complications were experienced. DBE procedures can be safely performed in patients with CD and should be considered for the precise evaluation of and to determine the treatment strategy for CD.

Extranodal NK/T cell lymphoma, nasal type, of the small intestine diagnosed by double-balloon endoscopy

Extranodal NK/T-cell lymphoma (ENKL), nasal type, is rare and the small intestine is quite extraordinary as a primary lesion site. We report a 47-year-old man with ENKL of the small intestine. He was referred to our hospital because of bloody stool and the diagnosis was made by double-balloon endoscopy (DBE) of the small intestine without surgical procedure. His clinical stage was IVB and he was categorized in group 4 by prognostic index of ENKL. He went into complete remission (CR) after intensive chemotherapy (DeVIC) and subsequently underwent allogeneic bone marrow transplantation (BMT). Although he remained in CR for about 8 months after BMT, he died of disease recurrence 14 months after the diagnosis was made. ENKL of the small intestine follows a highly aggressive course. We describe the usefulness of DBE for diagnosis and management for ENKL of the small intestine. Additional cases, however, should be accumulated to establish optimal treatment strategy.

Usefulness of Double Balloon Endoscopy in Patients With Surgically Distorted Intestinal Anatomy

Double balloon endoscopy (DBE) is a new endoscopic method with the capability for complete observation of whole small bowel. This study evaluated the feasibility and usefulness of DBE for the diagnosis and therapy of small bowel diseases in patients with distorted intestinal anatomy by previous surgeries. From January 2005 to August 2007, 15 patients with Roux-en-Y anastomosis underwent DBE in Asan Medical Center. Eight were men and the median age was 57 years (range, 40 to 68 y). Indications of DBE were suspected small bowel bleeding, chronic diarrhea, and recurrent acute pancreatitis. The main outcome measurements included completeness of the observation of afferent loop and DBE findings. Because 1 patient underwent DBE twice separately owing to recurrent bleeding, a total of 16 cases were analyzed. The observation of afferent loop was complete in 13 (81%) of 16 cases. The overall diagnostic yield of DBE was 69% (11/16). Out of 11 cases in which DBE detected abnormalities, 6 (55%) showed definite lesions and 5 (45%) probable lesions. Of the 11 cases in which abnormalities were found, 7 (64%) showed lesions in afferent loop. Of the 6 cases in which definite lesions were found, 4 (67%) showed lesions in afferent loop. Therapeutic endoscopic procedures were performed in 4 cases, which include argon plasma coagulation, foreign body removal, and endoscopic nasobiliary drainage. DBE in patients with distorted intestinal anatomy such as Roux-en-Y anastomosis is a useful tool for the management of small bowel lesions, especially those in the afferent loop.

Risk of Video Capsule Endoscope Retention and the Use of Double Balloon Endoscopy As the Primary Method for Video Capsule Endoscope Retrieval

Background and Aims: Capsule retention in the small bowel is a known complication of video capsule endoscopy. Surgery is the most frequently used method of capsule retrieval. The aims of this study were to determine the incidence and causes of capsule retention in a tertiary referral center for small bowel disease and to describe double balloon endoscopy as the primary technique used for capsule retrieval. Patients and Methods: Retrospective analysis of the incidence, causes, management and outcome of capsule retention in 904 video capsule studies performed in a tertiary referral center. Results: Capsule retention occurred in eight patients (incidence: 0.88%; 95% CI: 0.41% - 1.80%), and caused acute small bowel obstruction in six patients. In three of eight patients (37.5%) capsule retention was caused by lymphoma (diffuse large B-cell lymphoma, n=2; enteropathy associated T-cell lymphoma, n=1). In two of eight patients (25%) the cause for capsule retention was small bowel adenocarcinoma. In two of eight patients (25%) capsule retention was caused by postsurgical small bowel changes (blind loop, n=1; ulcerative anastomisis, n=1). One patient had capsule retention due to a Crohn's disease stricture. In this patient a patency capsule had passed without any abnormalities. All retained capsules were successfully removed during double balloon endoscopy. Six patients required elective surgery to treat the underlying cause of capsule retention. Conclusions: In our series, the incidence of capsule retention is low. One case of capsule retention occurred in a patient in whom a patency capsule had passed without abnormalities. Double balloon endoscopy is a safe and reliable method to remove retained capsules. Emergency endoscopy additionally allows tissue-sampling to obtain a diagnosis before elective surgery is performed.

Use of Double Balloon Endoscopy for the Early Diagnosis of Small Intestinal Malignant Neoplasms

Use of Double Balloon Endoscopy for the Early Diagnosis of Small Intestinal Malignant Neoplasms

Impact of double-balloon endoscopy on the diagnosis of jejunoileal involvement in primary intestinal follicular lymphomas: a case series

In recent years, primary gastrointestinal follicular lymphoma has been increasingly detected in the duodenum on esophagogastroduodenoscopy (EGD). Primary gastrointestinal follicular lymphomas are frequently distributed to multiple sites in the gastrointestinal tract. Therefore, investigation into the spread of follicular lymphomas in the small bowel is important in order to determine the most appropriate treatment strategy. The performance of double-balloon endoscopy (DBE) in the diagnosis of jejunoileal follicular lymphoma lesions has not been fully evaluated. We aimed to investigate the value of DBE in addition to computed tomography (CT) and (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) in the diagnosis of jejunoileal follicular lymphoma. DBE with biopsy was performed in seven patients with primary duodenal follicular lymphoma diagnosed by EGD, in order to investigate jejunoileal involvement. Jejunoileal follicular lymphoma lesions were detected by DBE in six out of the seven patients (three in the jejunum and three in the jejunum and ileum), whereas CT and (18)F-FDG-PET failed to detect the existence of these lesions. Endoscopic findings of the jejunoileal lesions revealed multiple white nodules and white villi, which were similar to those of duodenal lesions. DBE was more useful for the diagnosis of jejunoileal involvement in primary intestinal follicular lymphoma than CT and (18)F-FDG-PET. The use of DBE will become important for determining the most appropriate treatment for gastrointestinal follicular lymphoma.