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P200. Double-balloon endoscopy and Crohn's disease: Does it work?

S. Hülagu1, O. Sentürk1, G. Sirin1, A. Celebi1

1Kocaeli University, Gastroenterology, Kocaeli, Turkey

Background: Characteristic small bowel lesions observed with BAE in Crohn's disease are aphthoid ulcers, round ulcers, irregular ulcers and longitudinal ulcers. These ulcers tend to be located on the mesenteric side of the small bowel. Since BAE can determine the location (mesenteric or antimesenteric side) of the ulceration, it is useful in distinguishing Crohn's disease from other diseases that have ulcers in the small bowel. Strictures are a major clinical problem in the course of Crohn's disease. We aimed to evaluate the value of deep small-bowel endoscopy (DSBE) in the diagnosis of Crohns disease (CD).

Methods: This study is a retrospective analysis of 288 consecutive patients for investigation of small bowel disease that had been suspected by both clinical symptoms and imaging tests. The final management was guided by the results of DBE. Demographic, clinical, procedural and outcome data were collected for analysis.

Results: Among the 288 patients, lesions were found in 186 (64.5%). The main indication for DBE in our series was obscure gastrointestinal bleeding (32.4%). Suspected CD was 8.4%. The detection rate of CD was significantly higher with DSBE (70.1%) than with ileocolonscopy (45.6%, P < 0.05), and DBE provides much more detailed descriptions of specific endoscopic features such as segmental distribution and lumen changes. DBE significantly improve the diagnostic efficiency, giving priority to offer a guide and raise suspected diagnosis for CD.

Conclusions: DBE is a valuable modality for detecting CD lesions in the jejunum and ileum and for evaluating lesion involvement and severity. The combination with a comprehensive analysis of routine imaging findings, gastroendoscopy, colonoscopy and clinical data can further enhance the diagnostic efficiency of DSBE.