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Double‐balloon enteroscopy in the diagnosis of suspected isolated C rohn's disease of the small bowel
Author(s) -
Schulz Christian,
Mönkemüller Klaus,
Salheiser Maxi,
Bellutti Michael,
Schütte Kerstin,
Malfertheiner Peter
Publication year - 2014
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12142
Subject(s) - medicine , capsule endoscopy , enteroscopy , colonoscopy , gastroenterology , double balloon enteroscopy , esophagogastroduodenoscopy , crohn's disease , inflammatory bowel disease , radiology , endoscopy , stenosis , disease , colorectal cancer , cancer
Background and Aim Diagnosis of C rohn's disease ( CD ) with isolated involvement of the small bowel remains a major challenge. Diagnostic procedures allowing direct insight into the midgut have become available with the introduction of double‐balloon enteroscopy ( DBE ) and video‐capsule endoscopy ( VCE ). The aim of the present study was to evaluate the role of DBE in the diagnosis of isolated CD of the small bowel. Methods Sixteen patients (seven males) with suspected CD of the small bowel after exclusion of abnormal changes in the upper gastrointestinal tract and colon by esophagogastroduodenoscopy and colonoscopy including histology underwent DBE and high‐resolution transabdominal ultrasound. Results In seven of 16 (44%) patients, abnormal macroscopic findings were detected by DBE (e.g. ileitis terminalis, inflammatory stenosis, aphthous lesions or jejunal ulcers). In one of thecases, histology confirmed pathognomonic findings consistent with CD . However, the diagnosis of CD was confirmed in 11/16 (69%) patients taking into account the clinical presentation and course of the disease as well as the endoscopic and imaging results. Conclusions In cases of CD with clinical expression limited to the small bowel, DBE is a helpful tool. Nevertheless, in these patients, the combination of clinical findings and additional imaging modalities is required for confirmation of the diagnosis. A suggestive medical history, high‐resolution ultrasound, EGD and colonoscopy lead the algorithm before the assessment with DBE .