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P257. Double-balloon enteroscopy in Crohn's disease with small bowel involvement: the characteristics and clinical significance

S.R. Jeon1, J.-O. Kim1, H.G. Kim1, T.H. Lee1, W.J. Kim1, B.M. Ko1, J.Y. Cho1, J.S. Lee1, M.S. Lee1, 1Institute of Digestive Research, Soonchunhyang University College of Medicine, Department of Internal Medicine, Seoul, South Korea

Background

Diagnosis of Crohn's disease (CD) in small bowel (SB) is difficult beyond the reach of standard endoscopy. Although double-balloon enteroscopy (DBE) enables endoscopic visualization of the SB, the available data of CD with SB involvement is limited. Therefore, the aim of this study was to evaluate the characteristics by DBE and to identify clinical impact of DBE.

Methods

The study was conducted in a tertiary care center. We retrospectively analyzed 30 CD patients who were diagnosed by DBE (39 procedures) between September 2004 and October 2012. Phenotype was classified according to Montreal classification.

Results

The mean age of patients was 36.4 years and 73.2% of patients were male. The most common indication was to make the initial diagnosis (12/30, 40%). The mean number of procedures per patient was 1.3 and the elapsed time to the deepest point was 46.3±36.1 minutes. No complications occurred. CD activity was found: grade 1, 2, 3 and 4 were 26.7% (8/30), 36.7% (11/30), 0% and 36.7% (11/30), respectively. The extended CD was detected in 93.3% (28/30) and the most common behavior was B1 in 66.7% (20/30). Location of CD was as in the following: L4 (50%), L1+L4 (26.7%), L2+L4 (20%) and L1 (3.3%). Enteroscopic intervention and operation were conducted in 13.3% (clipping 1, balloon dilatation 2 and capsule endoscopy remove 1) and 3.3% (1/30), respectively. Of 27 patients except three who underwent DBE for therapeutic purpose, DBE identified all of 10 cases that had negative results from other modalities. Therapeutic plans were determined in 63.3% (19/30) on the basis of results from DBE.

Conclusion

DBE is a useful diagnostic tool for the diagnosis of CD patients with SB involvement. The clinical significance of DBE is emphasized by the fact that adjustment of therapy in up to 60% of these patients.