Diagnostic and Clinical Impact of Double-Balloon Enteroscopy in Small-Bowel Inflammatory Lesions: A Retrospective Cohort Study in a Turkish Population

Abstract

Background/Objectives: Small-bowel inflammatory lesions are challenging to diagnose thanks to their anatomical complexity and the limitations of conventional imaging. Double-balloon enteroscopy (DBE) allows for direct visualization, biopsy, and therapeutic intervention. This study evaluated the diagnostic yield and clinical impact of DBE in small-bowel inflammatory lesions, particularly in differentiating Crohn's disease (CD) from other etiologies. Methods: This retrospective study included 258 patients who underwent DBE for suspected small-bowel inflammatory lesions at Dokuz Eylül University Hospital (2010-2024). Patients were categorized into the CD and non-CD groups. The clinical, radiological, and endoscopic findings were also analyzed. Statistical comparisons were performed to assess the differences in presentation and DBE findings between the groups. Results: The mean patient age was 48.2 ± 17.3 years. Abdominal pain (47.7%) and diarrhea (31.8%) were the most common symptoms. The DBE findings included ulcers (45.0%), superficial mucosal changes (23.3%), and strictures (9.7%). The ileum was the most commonly affected site (31.7%). CD was diagnosed in 27.5% of the patients, while other etiologies included non-steroidal anti-inflammatory drug-induced (NSAID) enteropathy (12.0%) and malignancies (15.9%). Ulcers were significantly more frequent in patients with CD than in those without (60.3% vs. 39.0%, p = 0.002). Conclusions: DBE plays a crucial role in diagnosing small-bowel inflammatory lesions, distinguishing CD from other conditions, and guiding clinical management. It remains essential for cases requiring histopathological confirmation, offering superior diagnostic accuracy compared to noninvasive imaging.

Keywords: diagnostics; double-balloon enteroscopy; inflammatory lesions; small bowel.

Figure 1

Flowchart of the study.

Figure 2

Endoscopic images of small-bowel inflammatory lesions: (A) celiac disease, scalloping of jejunal fold; (B) celiac disease, ulcerative jejunitis; (C) Crohn’s disease, ileal stenosis; (D) Crohn’s disease, jejunal stenosis; (E) adenocarcinoma, jejunum; (F) lymphoma, jejunum; (G) non-steroidal anti-inflammatory drug-induced enteropathy, ileum; (H) graft-versus-host disease, jejunum; (I) autoimmune enteropathy, jejunum; (J) eosinophilic enteritis, jejunum; (K) amyloidosis, jejunum; and (L) lymphangiectasia, jejunum.