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P234. Double balloon endoscopy and Crohn's disease: Does it still work?

S. Hulagu, G. Sirin, O. Senturk, A. Celebi, Kocaeli University, Gastroenterology, Kocaeli, Turkey

Background

There are some characteristic small bowel lesions observed with balloon assisted endoscopy (BAE) in Crohn's disease like aphthoid ulcers, round ulcers, irregular ulcers and longitudinal ulcers. These ulcers generally 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. We aimed to investigate the impact of double-balloon endoscopy (DBE) in the diagnosis of Crohn's disease (CD).

Methods

This study is a retrospective analysis of 593 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 593 patients, lesions were found in 380 (64.1%). The main indication for DBE in our series was obscure gastrointestinal bleeding (35.4%) (Table 1).

Suspected CD was 8.76%. The detection rate of CD was significantly higher with DBE (68.6%) than with ileocolonoscopy (39.4%, P < 0.05), and DBE provides much more detailed descriptions of specific endoscopic features such as segmental distribution and lumen changes. Forty patients were diagnosed as new CD thanks DBE (Table 2).

Table 1. Kocaeli University Gastroenterology Department DBE series
IndicationNo. of patientsNo. of proceduresDiagnosis rate (%)
Obscure GI bleeding21025070.2
Crohn's disease528268.6
ERCP-Alterne GI tract455088.5
Total59379664.1
Table 2. Different indications and information of detecting CD
Aim of procedureNo. of patientsNo. of proceduresResults
Suspecting CD305221 new CD
Evaluate of known CD22309 new stricture, 11 expansion of involvement
Mid GI bleeding21025012 new CD
SB obstruction26364 new CD
Suspicious GI malignancy20393 New CD

Conclusion

DBE significantly improve the diagnostic efficiency, giving priority to offer a guide and raise suspected diagnosis for CD.