P114. Yield of double balloon enteroscopy in the investigation of possible or recurrent Crohn's disease
C. Parker1, R. Perowne1, D. Nylander2, S. Panter1, 1South Tyneside District Hospital, Gastroenterology, South Shields, United Kingdom, 2Royal Victoria Infirmary, United Kingdom
Double Balloon Enteroscopy (DBE) is used to investigate the small bowel. A DBE service at our institution was commenced in 2010 to complement the existing capsule endoscopy (CE) service. We audited the yield of DBE for the investigation of known and suspected Crohn's disease (CD).
The records of all patients attending for DBE were reviewed, those referred for further investigation of suspected or known CD were identified. Information was gathered regarding: referral reason, previous radiology and CE results, findings and histology of DBE and outcomes of DBE or management changes.
46 DBE's were performed on 42 patients, 20/42 were referred for investigation of CD. 5 had known CD, 15 had suspected CD. All 5 with known CD had abnormal imaging: 3/5 imaging suggested a stricture – all had abnormal DBE: inflammation in 2, stricture in 1. The other 2 cases (imaging suggested inflammation) had a normal DBE.
15 were referred with suspected CD. 2/15 were referred with symptoms/ raised faecal calprotectin, imaging and CE were normal – DBE was normal in both. In 4/15 the only imaging was an abnormal CE – DBE was abnormal and confirmed CD in 2/4. In the other 2 DBE was normal (anal and oral), there was concern from operator that the abnormal area was not reached. The remaining 9 patients had abnormal CE, abnormal radiology or both. 2/9 had abnormal CE with normal radiology and subsequent normal DBE. 6/9 had abnormal radiology (no CE, 1 had retained patency), 4/6 had abnormal DBE. 1/9 had abnormal CE and abnormal radiology and also had abnormal DBE.
6/15 possible CD patients were definitively diagnosed with CD on basis of DBE findings/ histology and in 50% of patients DBE informed a change in management; by therapy at time of DBE, confirmation of diagnosis by histology or DBE result leading to change in management.
Our findings suggest that DBE is a useful tool in the evaluation of patients with CD. DBE appears to be of limited value in those who have symptoms or biochemical abnormalities alone. Its role remains unclear for those with an abnormal CE but normal radiology; although it appears to add little our numbers are very small and our results could be affected by operator experience as it may be that the abnormal area seen on CE was not reached. We would suggest it is of particular value in assisting in management of those with known CD with possible recurrence or stricturing and in suspected CD for confirming the diagnosis in those with abnormal radiological imaging.