Clinical utility of double-balloon enteroscopy in suspected Crohn’s disease: a single-centre experience

Tun, Gloria Sz; Rattehalli, Deepa; Sanders, David S.; McAlindon, Mark E.; Drew, K; Sidhu, Reena

doi:10.1097/meg.0000000000000629

Cited by 29 publications

(25 citation statements)

References 26 publications

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“…Ideally, DBE can provide pathological support for the diagnosis of small bowel CD [22,23]. The histology usually detected in patients with established CD includes focal (discontinuous) chronic inflammation, focal crypt irregularities, and granulomas [6].…”

Section: Discussionmentioning

confidence: 99%

“…Non-caseous granuloma and at least one other microscopic feature (focal chronic inflammation or focal crypt irregularity) can be considered for CD [24]. In a retrospective study [22], despite positive macroscopic findings from DBE, 58% of the patients had normal or nonspecific histology, and 45% of patients were treated as having CD on the basis of a combination of histology, endoscopic appearance, clinical symptoms and laboratory tests. Although the discontinuity of inflammation and the superficiality of the biopsy tissue results in a lower chance of obtaining a granuloma under endoscopy, 10-30% of histological findings can still provide evidence to establish a diagnosis [25].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Background: Owing to the development of double-balloon enteroscopy (DBE) and video capsule endoscopy (VCE) in recent years, direct visualization of the entire small intestinal mucosa has become possible. Because of the nonspecific symptoms and the anatomic location of the small bowel, diagnosis of isolated small bowel Crohn's disease (CD) remains a challenge. The aim of this research was to explore the value of DBE for isolated small bowel CD in situations where routine tests cannot confirm the diagnosis. Methods: This study included patients with suspected isolated small bowel CD who were hospitalized in Shengjing Hospital from April 2014 to June 2018. We included patients presenting with 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 CD were excluded from this cohort. Patients with suspected isolated small bowel CD underwent DBE. Results: In 16/18 patients, pathological findings were detected by DBE. In 12 of the cases, small bowel CD was confirmed. The remaining four patients were diagnosed with small bowel inflammation, duodenal carcinoma, ileum inflammation and small bowel ulcers. However, the diagnosis of CD was confirmed in 14/18 (78%) patients by taking into account the clinical presentation, endoscopic and histological results as well as the experimental treatment. DBE assisted in the diagnosis in 86% (12/14) of the patients. Conclusions: In the diagnosis of small bowel CD, DBE is a helpful tool. Before assessment with DBE, clinical features, colonoscopy, and CT were used to initially assess the intestine. According to the lesions indicated by CT, we chose the most appropriate endoscope insertion route, and combined the endoscopic characteristics and pathological results of DBE to confirm the diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…A cobblestone-like appearance occurs when longitudinal ulcers pass through areas of normal or inflamed tissue [5]. Ideally, DBE can provide pathological support for the diagnosis of small bowel CD [22,23]. The histology usually detected in patients with established CD includes focal (discontinuous) chronic inflammation, focal crypt irregularities, and granulomas [6].…”

Section: Discussionmentioning

confidence: 99%

“…Noncaseous granuloma and at least one other microscopic feature (focal chronic inflammation or focal crypt irregularity) can be considered for CD [24]. In a retrospective study [22], despite positive macroscopic findings from DBE, 58% of the patients had normal or nonspecific histology, and 45% of patients were treated as having CD on the basis of a combination of histology, endoscopic appearance, clinical symptoms and laboratory tests. Although the discontinuity of inflammation and the superficiality of the biopsy tissue results in a lower chance of obtaining a granuloma under endoscopy, 10-30% of histological findings can still provide evidence to establish a diagnosis [25].…”

Section: Discussionmentioning

confidence: 99%

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

Huang

Liu

Yang

et al. 2020

Preprint

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Background : Owing to the development of double-balloon enteroscopy (DBE) and video capsule endoscopy (VCE) in recent years, direct visualization of the entire small intestinal mucosa has become possible. Because of the nonspecific symptoms and the anatomic location of the small bowel, diagnosis of isolated small bowel Crohn’s disease (CD) remains a challenge. The aim of this research was to explore the value of DBE for isolated small bowel CD in situations where routine tests cannot confirm the diagnosis. Methods : This study included patients with suspected isolated small bowel CD who were hospitalized in Shengjing Hospital from April 2014 to June 2018. We included patients presenting with 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 CD were excluded from this cohort. Patients with suspected isolated small bowel CD underwent DBE. Results: In 16/18 patients, pathological findings were detected by DBE. In 12 of the cases, small bowel CD was confirmed. The remaining four patients were diagnosed with small bowel inflammation, duodenal carcinoma, ileum inflammation and small bowel ulcers. However, the diagnosis of CD was confirmed in 14/18 (78%) patients by taking into account the clinical presentation, endoscopic and histological results as well as the experimental treatment. DBE assisted in the diagnosis in 86% (12/14) of the patients. Conclusions : In the diagnosis of small bowel CD, DBE is a helpful tool. Before assessment with DBE, clinical features, colonoscopy, and CT were used to initially assess the intestine. According to the lesions indicated by CT, we chose the most appropriate endoscope insertion route, and combined the endoscopic characteristics and pathological results of DBE to confirm the diagnosis.

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“…Utilisation of DBE also includes secondary assessment of pathology identified by other modalities including VCE and radiology. Other common indications for DBE include suspected small bowel Crohn’s disease,9 small bowel tumours,10 familial adenomatous polyposis and Peutz-Jeghers syndrome (PJS) 11…”

Section: Introductionmentioning

confidence: 99%

Paradigm shift: should the elderly undergo propofol sedation for DBE? A prospective cohort study

Ching

Branchi

Sanders

et al. 2017

Frontline Gastroenterol

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Clinical utility of double-balloon enteroscopy in suspected Crohn’s disease: a single-centre experience

Abstract: DBE has a useful place in clarifying the diagnosis in patients with suspected Crohn's disease. Although histology can be nondiagnostic, the combination of the macroscopic appearance with clinical correlation is useful in the diagnosis and management.

Cited by 29 publications

References 26 publications

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

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

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

Paradigm shift: should the elderly undergo propofol sedation for DBE? A prospective cohort study

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