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. 2014 Dec;2(4):E201-6.
doi: 10.1055/s-0034-1377522. Epub 2014 Nov 12.

Impact of balloon-assisted enteroscopy on the diagnosis and management of suspected and established small-bowel Crohn's disease

Udayakumar Navaneethan  1 , John J Vargo  1 , K V Narayanan Menon  1 , Madhusudhan R Sanaka  1 , Chung-Jyi Tsai  1
Affiliations

Impact of balloon-assisted enteroscopy on the diagnosis and management of suspected and established small-bowel Crohn's disease

Udayakumar Navaneethan et al. Endosc Int Open. 2014 Dec.

Abstract

Background and aims: The role of recently developed balloon-assisted enteroscopy (BAE) in small-bowel Crohn's disease (CD) is not well established. The purpose of this study is to determine the clinical impact of BAE on patients with suspected and established small-bowel CD.

Methods: This study included 22 patients (group A) with suspected small-bowel CD and 43 patients (group B) with established small-bowel CD with or without previous surgery, who underwent BAE, in a prospective BAE registry of a US academic medical institution. All underwent abdominal imaging studies including computed tomography (CT) or magnetic resonance (MR) enterography before BAE. The main outcome measurements were diagnostic yield and clinical outcomes.

Results: In total, 78 BAE procedures were carried out in 65 patients. In group A (n = 22, 25 BAE procedures), enteroscopy led to a diagnosis of CD in six patients (27.3 %). Non-steroidal anti-inflammatory drug-related enteropathy was diagnosed in three patients (13.6 %), whereas no lesions were found in the remaining 13 patients. In group B (n = 43, 53 BAE procedures) enteroscopy revealed active intestinal inflammation with ulcers and/or luminal stenosis in 18 patients (41.9 %), which led to a change and escalation of medical therapy. Five patients without active ulcers underwent successful dilation of small-bowel strictures with resulting resolution of obstructive symptoms. Of the 78 BAE procedures, two patients (2.6 %) had bleeding complications which were successfully treated conservatively. One patient (1.3 %) underwent surgery due to procedure-related perforation.

Conclusions: The use of BAE may help improve management in patients with suspected and established small-bowel CD.

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Conflict of interest statement

Competing interests: Dr John J. Vargo is on the speakers’ bureau of Boston Scientific and is a consultant for Olympus. Drs Udayakumar Navaneethan, K. V. Narayanan Menon, Madhusudhan R. Sanaka and Chung-Jyi Tsai have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Diagram summarizing the outcomes in patients with suspected small-bowel Crohn’s disease undergoing balloon assisted enteroscopy (BAE).
Fig. 2
Fig. 2
Diagram summarizing the outcomes in patients with established small-bowel Crohn’s disease undergoing balloon assisted enteroscopy (BAE).
Fig. 3
Fig. 3
Fibrotic stricture from Crohn’s disease in the mid-jejunum.
Fig. 4
Fig. 4
Treatment of the stricture in the mid-jejunum by balloon assisted enteroscopy (BAE) and through-the-scope balloon dilation.
Fig. 5
Fig. 5
Active inflammatory stricture from Crohn’s disease in the ileum which required an escalation in medical treatment.
See this image and copyright information in PMC

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