Evaluation of Deep Small Bowel Involvement by Double-Balloon Enteroscopy in Crohn's Disease
Double-balloon enteroscopy (DBE) enables inspection of deep small bowel, and total small bowel examination can be performed by either antegrade or retrograde DBE. The aim of this study was to evaluate ileal involvement, which cannot be achieved using conventional colonoscopy, by DBE in patients with Crohn's disease.
From December 2003 to September 2005, a total of 44 patients with Crohn's disease underwent 53 examinations using DBE.
Forty patients with Crohn's disease, seven women and 33 men, underwent DBE, and the ileum was investigated in 38 patients. There were 25 cases of ileitis, 2 of colitis, and 13 of ileocolitis. Jejunal lesions were found in two and ileal lesions proximal to the terminal ileum were found in 24 patients with Crohn's disease. DBE was superior to radiological study to detect aphthae, erosions, and small ulcers in the ileum. Small bowel stricture was demonstrated in six and nine patients with DBE and small bowel barium study (SBBS), respectively. An additional mucosal finding was demonstrated in one of the eight patients who underwent wireless capsule endoscopy, and one patient had a capsule removed by DBE that had become lodged because of an ileal stricture. One ileal perforation because of overtube balloon pressure occurred in 53 examinations of patients with Crohn's disease (1.9%).
DBE is useful to evaluate small bowel lesions in patients with Crohn's disease; however, special attention should be paid to mesenteric longitudinal ulcers during insertion and the overtube balloon should not be inflated if a clear intestinal view is not possible.
Available from: PubMed Central
- "BAE can be used to examine the deep small bowel, and BAE revealed small bowel disease activity that was beyond the reach of conventional endoscopy in 60% to 89% of the patients.23,24 Oshitani et al.23 reported that, of 38 CD patients who underwent DBE for evaluation of small bowel involvement, seven patients had terminal ileum disease, and ileal involvement proximal to the terminal ileum was revealed in 27 CD patients. Of these 27 patients, 24 patients (89%) had no involvement of the terminal ileum. "
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ABSTRACT: Crohn disease (CD) is a chronic inflammatory bowel disease that affects the entire gastrointestinal tract but is most frequently localized to the large and small bowel. Small bowel endoscopy helps with the differential diagnosis of CD in suspected CD patients. Early diagnosis of CD is preferable for suspected CD conditions to improve chronic inflammatory infiltrates, fibrosis. Small bowel endoscopy can help with the early detection of active disease, thus leading to early therapy before the onset of clinical symptoms of established CD. Some patients with CD have mucosal inflammatory changes not in the terminal ileum but in the proximal small bowel. Conventional ileocolonoscopy cannot detect ileal involvement proximal to the terminal ileum. Small bowel endoscopy, however, can be useful for evaluating these small bowel involvements in patients with CD. Small bowel endoscopy by endoscopic balloon dilation (EBD) enables the treatment of small bowel strictures in patients with CD. However, many practical issues still need to be addressed, such as endoscopic findings for early detection of CD, application compared with other imaging modalities, determination of the appropriate interval for endoscopic surveillance of small bowel lesions in patients with CD, and long-term prognosis after EBD.
Available from: Tom G Moreels
- "Therefore, inflammatory and ulcerative strictures should be primarily treated by rigorous medical therapy. Several cases have described retained WCE due to intestinal CD strictures, successfully removed by DAE, again avoiding surgical intervention [25,30,34,37]. Finally, local injection of immunomodulatory drugs like corticosteroids and the anti-tumor-necrosis-factor-α antibody infliximab in the four quadrants of CD stricture may become a potentially interesting therapeutic strategy . "
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ABSTRACT: Endoscopic assessment of the small bowel is difficult because of its long and tortuous anatomy. However, recent developments have greatly improved the insertion depth and diagnostic yield, by means of device-assisted enteroscopy (DAE). Therefore, DAE may be of specific interest in the diagnostic and therapeutic approach of patients with inflammatory bowel disease. It may be of help in the diagnostic assessment of intestinal disease extent and severity and complications, with an impact on the therapeutic management. Moreover, local treatment within the small bowel is also feasible with DAE. This review aims to provide an overview of the currently available literature data on the use of enteroscopy in inflammatory bowel disease, and Crohn's disease in particular.
Available from: Hironori Yamamoto
- "In recent years, however, new endoscopic modalities such as capsule endoscopy (CE) [Iddan et al. 2000] and balloon-assisted endoscopy (BAE) including both double-balloon endoscopy (DBE) [Monkemuller et al. 2007; Zhong et al. 2007; Heine et al. 2006; May and Ell, 2006; Yamamoto et al., 2001] and singleballoon endoscopy (SBE) have been developed. These instruments have enabled us to obtain clear endoscopic images of the small bowel which are useful in making more accurate diagnosis and evaluation of the small bowel lesions in Crohn's disease [Oshitani et al. 2006]. "
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ABSTRACT: With the recent development of double-balloon endoscopy (DBE) and capsule endoscopy (CE), it has become possible to observe the entire small bowel endoscopically. DBE enables us to make detailed observations and at the same time takes biopsy samples. Single-balloon endoscopy (SBE), which has a balloon only at the tip of the overtube, has also been introduced. Since DBE and SBE are similar in the concept of insertion method, a general term 'balloon-assisted endoscopy' (BAE) is used when referring to these methods. Characteristic small bowel lesions observed with BAE in Crohn's disease are aphthoid ulcers, round ulcers, irregular ulcers and longitudinal ulcers. These ulcers tend to be located on the mesenteric side of the small bowel. Since BAE can determine the location (mesenteric or antimesenteric side) of the ulceration, it is useful in distinguishing Crohn's disease from other diseases that have ulcers in the small bowel. Strictures are a major clinical problem in the course of Crohn's disease. Traditionally, surgery was the main choice for small bowel strictures. In some cases, strictures located in distal ileum or proximal jejunum have been dilated using standard enteroscopes. DBE now enables balloon dilatation to be performed endoscopically even in the deep small bowel.
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