Successful retrieval of video capsule endoscopy retained at ileal stenosis of Crohn's disease using double-balloon endoscopy

Background. Although the usefulness of capsule endoscopy (CE) and double-balloon endoscopy (DBE) for the evaluation of Crohn’s disease (CD) is established, their capabilities in the differential diagnosis of small bowel stenosis have not been sufficiently addressed. The present study therefore aimed to retrospectively determine the types of patients for whom CE and DBE would confer the most benefit.Patients and Methods. We retrospectively reviewed data from 185 patients with established CD. A change of treatment based on CE or DBE results or successful DBE balloon dilation was defined as clinically useful indication. We then analyzed the factors significantly related to useful and poor indications.Results. CE results were assessed as useful indications in 28 (45%) of 62 patients. Multivariate analysis demonstrated that positive CRP and low IOIBD score are factors significantly related to a useful indication. DBE results were recognized as useful indications in 118 (77%) of 153 patients. Multivariate analysis indicated small bowel stenosis and abdominal pain as factors significantly associated with useful indications. All patients with a poor indication on CE had small bowel stenosis.Conclusions. CE was most useful for patients in clinical remission with positive CRP and without stenosis, whereas DBE was useful for patients with symptoms of stenosis.

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Diagnostic efficacy of double-balloon enteroscopy in patients with suspected isolated small bowel Crohn’s disease

10.21203/rs.2.13290/v1 ◽

2019 ◽

Author(s):

Zihan Huang ◽

Xiang Liu ◽

Fei Yang ◽

Guoxin Wang ◽

Nan Ge ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Capsule Endoscopy ◽

Abdominal Mass ◽

Video Capsule Endoscopy ◽

Small Intestinal Mucosa ◽

Double Balloon Enteroscopy ◽

Balloon Enteroscopy ◽

Double Balloon

Abstract Background Due to the development of double-balloon enteroscopy and video capsule endoscopy, direct visualization of the entire small intestinal mucosa has been achieved. Compared with video capsule endoscopy, double-balloon enteroscopy has the advantages of biopsy samples and endoscopic treatment. The aim of this research was to explore the value of double-balloon enteroscopy for isolated small bowel Crohn’s disease. Methods This study included patients with suspected isolated small bowel Crohn’s disease who were hospitalized in Shengjing Hospital from April 2014 to June 2018. We included patients with symptoms of chronic diarrhea, abdominal pain, abdominal mass, perianal lesions, and systemic symptoms including weight loss, fever, and anemia after excluding infection factors. Patients with purely colonic Crohn’s disease were excluded from this cohort. Patients with suspected isolated small bowel Crohn’s disease underwent double-balloon enteroscopy. Results With clear endoscopic images and histological support, 14 patients were diagnosed with isolated small bowel Crohn’s disease. Three patients who were diagnosed with small bowel Crohn’s disease by double-balloon enteroscopy showed improved morphological features of the small bowel when the double-balloon enteroscopy was reviewed after medical treatment. Conclusions The diagnosis of Crohn’s disease is usually based on the patient’s clinical history and related examinations. Double-balloon enteroscopy provides imaging support and histological support for the definitive diagnosis of Crohn’s disease and can be considered as a useful tool to evaluate the therapeutic efficacy in the future.

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