Double-balloon enteroscopy in Crohn's disease: findings and impact on management in a multicenter retrospective study

Abstract

Background: Double-balloon enteroscopy (DBE) is effective in visualizing the small bowel to perform biopsy sampling and interventions. Few studies have evaluated the utility of DBE in patients with known or suspected Crohn's disease (CD).

Objective: To evaluate the use of DBE in the diagnosis and impact on patient management in known and suspected CD and to compare capsule endoscopy (CE) with DBE findings.

Design: Retrospective study from August 2004 to August 2009 of DBE procedures.

Setting: Five academic, tertiary U.S. centers.

Patients: Patients with known or suspected CD.

Main outcome measures: Diagnostic yield, impact on patient management, and comparison of DBE to CE findings in patients with known and suspected CD.

Results: We analyzed 98 DBE procedures performed in 81 patients (38 with known CD and 43 with suspected CD). For patients with CD, common indications were abdominal pain and bleeding/anemia. The diagnostic yield was 87% (33/38 patients). The impact on subsequent management decisions was 82% (31/38). Common indications for DBE in patients with suspected CD were abnormal CE or other imaging. The diagnostic yield was 79% (34/43 patients). The impact on subsequent management decisions was 77% (33/43). In 17% of patients (14/81), DBE failed to reach the target lesion. There was 1 perforation, 3 strictures dilated, and 1 of 2 retained capsules recovered. When CE was followed by DBE, 46% of lesions were confirmed on DBE.

Limitations: Retrospective analysis, imperfect criterion standard.

Conclusions: DBE is an effective technique for assessment of the small bowel in known and suspected CD and affects management. Failure to reach target areas with DBE is not uncommon, and perforations can occur. There is poor correlation between CE and DBE.