Impact of double-balloon enteroscopy findings on the management of Crohn's disease

Scand J Gastroenterol. 2010 Apr;45(4):483-9. doi: 10.3109/00365520903563774.

Abstract

Objective: It is estimated that 10%-30% of Crohn's disease (CD) patients have small-bowel lesions, but the exact frequency and clinical relevance of these findings are unknown. Double-balloon enteroscopy (DBE) enables endoscopic visualization of the small bowel. The aim of this study was to evaluate the use of DBE for detecting small-bowel lesions in CD patients suspected of having small-bowel involvement. Furthermore, the clinical impact of adjusting treatment in these patients was assessed.

Material and methods: A prospective study was performed in a tertiary referral center. CD patients suspected of small-bowel involvement and in whom distal activity had previously been excluded were included. All patients underwent DBE, followed by step-up therapy in patients with small-bowel lesions. The presence of small-bowel lesions during DBE was noted and clinical outcome was assessed after adjusting therapy.

Results: Thirty-five patients (70%) showed small-bowel lesions; these lesions could not be assessed by conventional endoscopy in 23 (46%). At 1-year follow-up, step-up therapy in 26 patients (74%) led to clinical remission in 23 (88%). This was confirmed by a significant decrease in Crohn's disease activity index and mucosal repair on second DBE.

Conclusions: DBE showed a high frequency of small-bowel lesions in known CD patients with clinically suspected small-bowel activity. Most of these lesions were not accessible for conventional endoscopy. Adjusting treatment in patients with small-bowel CD involvement led to clinical remission and mucosal repair in the majority of cases.

MeSH terms

  • Adult
  • Aged
  • Catheterization*
  • Chi-Square Distribution
  • Crohn Disease / pathology*
  • Crohn Disease / therapy
  • Endoscopy, Gastrointestinal*
  • Female
  • Humans
  • Intestine, Small / pathology*
  • Male
  • Middle Aged
  • Prospective Studies
  • Statistics, Nonparametric
  • Treatment Outcome