Enteroscopy in Crohn’s Disease: Are There Any Changes in Role or Outcomes Over Time? A KASID Multicenter Study

Abstract

Background/Aims: Although balloon-assisted enteroscopy (BAE) enables endoscopic visualization of small bowel (SB) involvement in Crohn's disease (CD), there is no data on the changes in outcomes over time. We therefore investigated the changes in BAE use on CD patients over different time periods in terms of its role and clinical outcomes. Methods:We used a multicenter enteroscopy database to identify CD patients with SB involvement who underwent BAE (131 procedures, 116 patients). We compared BAE-related factors and outcomes between the first period (70 procedures, 60 patients) and the second period (61 procedures, 56 patients). The specific cutoff point for dividing the two periods was 2007, when BAE guidelines were introduced.Results: Initial diagnosis of SB involvement in CD was the most common indication for BAE during each period (50.0% vs 31.1%, p=0.034). The largest change was in the number of BAE uses for stricture evaluation and/or treatment, which increased significantly in the latter period (2.9% vs 21.3%, p=0.002). The diagnostic yield in patients with suspected CD was 90.7% in the first period and 95.0% in the second (p=0.695). More endoscopic interventions were performed in the second period than in the first (5.1% vs 17.6%, p=0.041). Enteroscopic success rates were high throughout (100% in the first period vs 80.0% in the second period, p>0.999). In the first and second periods, therapeutic plans were adjusted in 62.7% and 61.4% of patients, respectively. Conclusions:The overall clinical indications, outcomes, and effectiveness of BAE were constant over time in CD patients with SB involvement, with the exception that the frequency of enteroscopic intervention increased remarkably. (Gut Liver 2021;15:375-382)

Is Paradigm for the Role of Balloon-Assisted Enteroscopy Changing in Crohn’s Disease?

“… 10 Stricture dilatation with BAE has been shown to have a high technical success rate (94.9%) and a low rate of major complications (5.3%). 10 Consistent with the result of previous reports, the study by Jeon et al 9 also showed a high technical success rate of over 80%. 9 One of the most notable findings of this study is that the use of BAE related to small bowel strictures was significantly increased in the second period compared to that in the first period (2.9% vs 21.3%, p=0.002).…”

“… 10 Consistent with the result of previous reports, the study by Jeon et al 9 also showed a high technical success rate of over 80%. 9 One of the most notable findings of this study is that the use of BAE related to small bowel strictures was significantly increased in the second period compared to that in the first period (2.9% vs 21.3%, p=0.002). This finding indicates that BAE is expanding its scope to diagnosis as well as treatment of SBCD.…”

“…Thus, recently published Japanese guidelines also stated that BAE may be useful for close observation and monitoring of SB lesions in CD. 8 In the current issue, Jeon et al 9 reported data comparing BAE-related factors and clinical outcomes of BAE use in SBCD over time. From A multicenter database of patients with CD with small bowel lesions who underwent BAE, 131 procedures in 116 patients were included.…”

“…In the current issue, Jeon et al 9 reported data comparing BAE-related factors and clinical outcomes of BAE use in SBCD over time. From A multicenter database of patients with CD with small bowel lesions who underwent BAE, 131 procedures in 116 patients were included.…”

Intestinal strictures in Crohn’s disease: a 2021 update

“… 65 A multicenter study in 2021 showed that the frequency of endoscopic diagnosis was significantly increased in CD patients with SB strictures, but its diagnostic yield did not change over time. 66 Integrating artificial intelligence (AI) technology with endoscopy may be a solution to this problem. Studies showed that AI was faster and more accurate when detecting crucial subtle lesions compared with an endoscopist, although they had a comparable diagnostic performance to some extent.…”