Application Of Balloon-assisted Enteroscopy(BAE) In Diagnosis And Treatment Of Small Bowel Crohn’s Disease

Objectives:1. To investigate the value of double-balloon enteroscopy in the diagnosis of smallbowel Crohn′s disease (CD).2. Bowel obstruction is one of the most common complications of Crohn’s disease, asa result of multi-segment stricture in the small bowel. The aim of the study is to evaluatethe efficacy and safety of endoscopic balloon dilatation with single balloon enterscopy(SBE).Methods:1. A retrospective summary is made of the clinical data of141patients undergoingdouble-balloon enteroscopy (DBE) who were suspected of small intestinal crohn’s disease.Of the141patients，25underwent CT enterography (CTE),25underwent capsuleendoscopy (CE).Using pathological diagnosis combined with endoscopic findings andclinic follow-up results as the final diagnosis, a comparative analysis is conducted of thedetectable rate, diagnosis rate, sensitivity and specificity of small bowel Crohn’s disease bydouble-balloon enteroscopy (DBE), CT enterography(CTE) and capsule endoscopy (CE).2. Totally seven patients diagnosed with obstruction presented Crohn’s disease wereenrolled, including four males and three females with a mean age of37.6years old.Previous double-balloon enteroscopy (DBE) has confirmed6strictures in jejunum and2strictures in ileum. The average diameter of stricture was4.1±2.5mm before therapy.During the oral or anal single balloon enteroscopy(SBE), a CRE balloon was used to dilatethe stricture. The success was defined as the scope of single balloon enteroscopy(SBE)could pass the narrow segment and reach the further enteric cavity.Results：1.Of the141patients,128had their diagnosis established by double-balloonenteroscopy(DBE) and126were ultimately confirmed by pathological and clinicpresentation. The detectable rate and diagnosis rate of small bowel Crohn’s disease inpatients undergoing double-balloon enteroscopy(DBE) were90.8%(128/141) and98.4%(126/128). Nineteen of25cases(76%) had positive findings with CT enterography.Seventeen of19patients were ultimately confirmed by pathological and clinic follow-up,the diagnosis rate of small bowel Crohn’s disease by the examination of CT enterography was89.5%(17/19). Fifteen of25patients (60%) had lesions detected through capsuleendoscopy examination. The diagnosis was finally confirmed by pathological and clinicfollow-up in14patients (93.3%).The sensitivity and specificity of double-balloonenteroscopy (DBE) were100%and86.7%, and that of CT enterography (CTE) were81%and50%. The sensitivity and specificity of capsule endoscopy (CE) were70%and80%.2. The overall success rate of SBE-assisted small bowel dilation is80%(8/10). Theaverage diameter of stricture became10.2±1.5mm after dilatation (P<0.01vs pre-therapy)and further distal62.5cm length bowel could be observed. All patients’ obstructionsymptoms disappeared and no complication of bleeding or perforation occurred after theprocedure. During the follow-up time of14months, two patients were performed surgeryand the other two were dilated again. The median symptom-free period is15.0months andone year recurrence rate is only30%.Conclusions：1. Double-balloon enteroscopy (DBE) has a high application value in the diagnosis ofsmall bowel Crohn’s disease. It was an ideal diagnostic modality for small bowel Crohn′sdisease for its high diagnostic yield and accuracy. To the patients with endoscopycontraindications, CT enterography(CTE) can be considered as a preferred auxiliarydiagnostic modality. Capsule endoscopy(CE) has a certain value in early screening ofsmall bowel Crohn′s disease．But for patients with clinical suspicion of obstructions,capsule endoscopy (CE)should be used with caution．3. The dilation of small bowel stricture is a new method to release theobstruction in Crohn’s disease. The treatment is safe if the pressure of dilating balloon iscontrolled properly and can be an optional method other than surgery for such patients.