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P306 Double balloon enteroscopy in paediatric Crohn’s disease and 10 years follow-up

J. Oba*1,2, A. Carlos3, M. Azevedo3, L. Milani3, N. Freitas4, R. Toma5, M. Bibas5, A. Damião3, A. Safatle-Ribeiro3

1São Paulo University Medical School, Pediatric, São Paulo, Brazil, 2Hospital Israelita Albert Einstein, GI, São Paulo, Brazil, 3Hospital das Clínicas HCFMUSP, Gastroenterology, São Paulo, Brazil, 4Hospital das Clínicas HCFMUSP, Surgery, São Paulo, Brazil, 5Instituto da Criança HCFMUSP, Pediatric, São Paulo, Brazil

Background

Crohn’s disease can occur throughout the entire gastrointestinal tract, often discontinuously, with the ileum and colon being the most common site. However, CD may involve any region of the small bowel (SB) other than the ileum and colon and isolated SB CD can present a diagnostic challenge. Double Balloon Enteroscopy (DBE) is an endoscopic modality for children that allow the diagnostic and therapeutic procedures of SB disease. Our aim was to evaluate the SB by DBE in children refractory to CD treatment

Methods

Between 2007 and 2010, 20 paediatric patients (age 2–17 years) with CD diagnosis, refractory to treatment were selected to undergo SB by DBE. The main objective was to evaluate SB inflammation-related, narrowing, malignancy or other diseases. Previously, all had performed radiological imaging to exclude stricturing. Only one experienced endoscopist performed all the DBE. In addition, 10 years follow-up with therapy was analysed

Results

The mean patient age was 12 years (range 2–17 years). Four patients (5%) had SB CD solely in jejunum, which was not detected by either colonoscopy or radiological examination (Table)

CD patient at diagnosis10-year follow-up
Patients (n)/median age (years)20/1214/22
Sex (%)M65/ F35M64/ F36
DBE lesions, %90
Initial therapy (%)Therapy at 10 years follow-up (%)
5-Aminosalicylic acid257
Corticosteroid6028
Thiopurine/methotrexate805
Infliximab, adalimumab7028
No treatment21

Sociodemographic data.

DBE lesions were: Active duodenojejunal ulcers, mucosal healing and/or pseudo polyps and mucosal granularity. General anaesthesia was performed in 6 children from 2 to 7 years and deep sedation with propofol in 14 patients. Mean length of SB examined was 220 cm beyond the ligament of Treitz (range 120 to 360 cm). Mean duration of the procedure: 48 min (range 30 to 60). No significant complications were related to the procedure. One patient had a malignancy diagnosis extra-intestinal; one had IL-10 and/or IL-10R gene mutation and one change the diagnosis to ulcerative colitis. Currently, 14 patients are in follow-up, 5 children in paediatric GI clinic and the other 9 at adult GI clinic. Curiously, the proportion of patients free of long-term therapy has decreased.

Conclusion

We conclude DBE is a safe and useful tool to clarify SB pathologies in paediatric patients like CD. DBE can provide additional information in patients who require therapeutic decision or to make differential diagnosis. In addition is allows biopsy sampling. General anaesthesia or sedation and should be considered