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Published in: Journal of Gastroenterology 7/2010

01-07-2010 | Original Article—Alimentary Tract

Roles of double-balloon endoscopy in the diagnosis and treatment of Crohn’s disease: a multicenter experience

Authors: Jumpei Kondo, Hideki Iijima, Takashi Abe, Masato Komori, Satoshi Hiyama, Toshifumi Ito, Akihiro Nakama, Kouhei Tominaga, Mitsuhiko Kubo, Kunio Suzuki, Yoshihisa Iwanaga, Ryoichi Ebara, Akira Takeda, Shingo Tsuji, Tsutomu Nishida, Shusaku Tsutsui, Masahiko Tsujii, Norio Hayashi

Published in: Journal of Gastroenterology | Issue 7/2010

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Abstract

Background

Double-balloon endoscopy (DBE) examinations are not yet widely accepted as routine procedures for examining the small bowel of patients with Crohn’s disease (CD).

Aim

To evaluate the feasibility and usefulness of DBE for CD in tertiary-care hospitals.

Methods

Between July 2004 and September 2008, 1444 DBE procedures were performed for 704 patients in 6 tertiary-care hospitals. Patient profile, indication, diagnosis and treatment of DBE were evaluated using a multicenter database.

Results

DBE examinations were most frequently performed in 75 patients with CD, corresponding to 10.5% of all the patients examined by DBE. Fifty patients were diagnosed with CD before DBE, while DBE was performed for the diagnosis of 25 new CD patients. Small bowel lesions were often detected even when the terminal ileum was not involved. In the 75 patients, 21 patients were asymptomatic at the time of DBE examinations. Active inflammatory lesions were detected in 51.2% of the CD patients, and were even detected in 33.3% of the asymptomatic CD patients. The treatment was altered in 53.3% of the CD patients after the DBE evaluation. No severe complications were experienced.

Conclusions

DBE procedures can be safely performed in patients with CD and should be considered for the precise evaluation of and to determine the treatment strategy for CD.
Literature
3.
go back to reference Costamagna G, Shah SK, Riccioni ME, Foschia F, Mutignani M, Perri V, et al. A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease. Gastroenterology. 2002;123:999–1005.CrossRefPubMed Costamagna G, Shah SK, Riccioni ME, Foschia F, Mutignani M, Perri V, et al. A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease. Gastroenterology. 2002;123:999–1005.CrossRefPubMed
4.
go back to reference Ell C, Remke S, May A, Helou L, Henrich R, Mayer G. The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding. Endoscopy. 2002;34:685–9.CrossRefPubMed Ell C, Remke S, May A, Helou L, Henrich R, Mayer G. The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding. Endoscopy. 2002;34:685–9.CrossRefPubMed
5.
go back to reference Fireman Z, Mahajna E, Broide E, Shapiro M, Fich L, Sternberg A, et al. Diagnosing small bowel Crohn’s disease with wireless capsule endoscopy. Gut. 2003;52:390–2.CrossRefPubMed Fireman Z, Mahajna E, Broide E, Shapiro M, Fich L, Sternberg A, et al. Diagnosing small bowel Crohn’s disease with wireless capsule endoscopy. Gut. 2003;52:390–2.CrossRefPubMed
6.
go back to reference Yamamoto H, Sekine Y, Sato Y, Higashizawa T, Miyata T, Iino S, et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc. 2001;53:216–20.CrossRefPubMed Yamamoto H, Sekine Y, Sato Y, Higashizawa T, Miyata T, Iino S, et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc. 2001;53:216–20.CrossRefPubMed
7.
go back to reference May A, Nachbar L, Ell C. Double-balloon enteroscopy (push-and-pull enteroscopy) of the small bowel: feasibility and diagnostic and therapeutic yield in patients with suspected small bowel disease. Gastrointest Endosc. 2005;62:62–70.CrossRefPubMed May A, Nachbar L, Ell C. Double-balloon enteroscopy (push-and-pull enteroscopy) of the small bowel: feasibility and diagnostic and therapeutic yield in patients with suspected small bowel disease. Gastrointest Endosc. 2005;62:62–70.CrossRefPubMed
8.
go back to reference Ell C, May A, Nachbar L, Cellier C, Landi B, di Caro S, et al. Push-and-pull enteroscopy in the small bowel using the double-balloon technique: results of a prospective European multicenter study. Endoscopy. 2005;37:613–6.CrossRefPubMed Ell C, May A, Nachbar L, Cellier C, Landi B, di Caro S, et al. Push-and-pull enteroscopy in the small bowel using the double-balloon technique: results of a prospective European multicenter study. Endoscopy. 2005;37:613–6.CrossRefPubMed
9.
go back to reference Heine GD, Hadithi M, Groenen MJ, Kuipers EJ, Jacobs MA, Mulder CJ. Double-balloon enteroscopy: indications, diagnostic yield, and complications in a series of 275 patients with suspected small-bowel disease. Endoscopy. 2006;38:42–8.CrossRefPubMed Heine GD, Hadithi M, Groenen MJ, Kuipers EJ, Jacobs MA, Mulder CJ. Double-balloon enteroscopy: indications, diagnostic yield, and complications in a series of 275 patients with suspected small-bowel disease. Endoscopy. 2006;38:42–8.CrossRefPubMed
10.
go back to reference Di Caro S, May A, Heine DG, Fini L, Landi B, Petruzziello L, et al. The European experience with double-balloon enteroscopy: indications, methodology, safety, and clinical impact. Gastrointest Endosc. 2005;62:545–50.CrossRefPubMed Di Caro S, May A, Heine DG, Fini L, Landi B, Petruzziello L, et al. The European experience with double-balloon enteroscopy: indications, methodology, safety, and clinical impact. Gastrointest Endosc. 2005;62:545–50.CrossRefPubMed
11.
go back to reference Yamamoto H, Kita H, Sunada K, Hayashi Y, Sato H, Yano T, et al. Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol. 2004;2:1010–6.CrossRefPubMed Yamamoto H, Kita H, Sunada K, Hayashi Y, Sato H, Yano T, et al. Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol. 2004;2:1010–6.CrossRefPubMed
12.
go back to reference Ohmiya N, Taguchi A, Shirai K, Mabuchi N, Arakawa D, Kanazawa H, et al. Endoscopic resection of Peutz–Jeghers polyps throughout the small intestine at double-balloon enteroscopy without laparotomy. Gastrointest Endosc. 2005;61:140–7. Ohmiya N, Taguchi A, Shirai K, Mabuchi N, Arakawa D, Kanazawa H, et al. Endoscopic resection of Peutz–Jeghers polyps throughout the small intestine at double-balloon enteroscopy without laparotomy. Gastrointest Endosc. 2005;61:140–7.
13.
go back to reference Mekhjian HS, Switz DM, Melnyk CS, Rankin GB, Brooks RK. Clinical features and natural history of Crohn’s disease. Gastroenterology. 1979;77:898–906.PubMed Mekhjian HS, Switz DM, Melnyk CS, Rankin GB, Brooks RK. Clinical features and natural history of Crohn’s disease. Gastroenterology. 1979;77:898–906.PubMed
14.
go back to reference Steinhardt HJ, Loeschke K, Kasper H, Holtermuller KH, Schafer H. European Cooperative Crohn’s Disease Study (ECCDS): clinical features and natural history. Digestion. 1985;31:97–108.CrossRefPubMed Steinhardt HJ, Loeschke K, Kasper H, Holtermuller KH, Schafer H. European Cooperative Crohn’s Disease Study (ECCDS): clinical features and natural history. Digestion. 1985;31:97–108.CrossRefPubMed
15.
go back to reference Voderholzer WA, Beinhoelzl J, Rogalla P, Murrer S, Schachschal G, Lochs H, et al. Small bowel involvement in Crohn’s disease: a prospective comparison of wireless capsule endoscopy and computed tomography enteroclysis. Gut. 2005;54:369–73.CrossRefPubMed Voderholzer WA, Beinhoelzl J, Rogalla P, Murrer S, Schachschal G, Lochs H, et al. Small bowel involvement in Crohn’s disease: a prospective comparison of wireless capsule endoscopy and computed tomography enteroclysis. Gut. 2005;54:369–73.CrossRefPubMed
16.
go back to reference Pimentel M, Chang M, Chow EJ, Tabibzadeh S, Kirit-Kiriak V, Targan SR, et al. Identification of a prodromal period in Crohn’s disease but not ulcerative colitis. Am J Gastroenterol. 2000;95:3458–62.CrossRefPubMed Pimentel M, Chang M, Chow EJ, Tabibzadeh S, Kirit-Kiriak V, Targan SR, et al. Identification of a prodromal period in Crohn’s disease but not ulcerative colitis. Am J Gastroenterol. 2000;95:3458–62.CrossRefPubMed
17.
go back to reference Cosnes J, Cattan S, Blain A, Beaugerie L, Carbonnel F, Parc R, et al. Long-term evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis. 2002;8:244–50.CrossRefPubMed Cosnes J, Cattan S, Blain A, Beaugerie L, Carbonnel F, Parc R, et al. Long-term evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis. 2002;8:244–50.CrossRefPubMed
18.
go back to reference Gay G, Delvaux M. Double balloon enteroscopy in Crohn’s disease and related disorders: our experience. Gastrointest Endosc. 2007;66:S82–90.CrossRefPubMed Gay G, Delvaux M. Double balloon enteroscopy in Crohn’s disease and related disorders: our experience. Gastrointest Endosc. 2007;66:S82–90.CrossRefPubMed
19.
go back to reference Pennazio M. Crohn’s disease: diagnostic and therapeutic potential of modern small-bowel endoscopy. Gastrointest Endosc. 2007;66:S91–3.CrossRefPubMed Pennazio M. Crohn’s disease: diagnostic and therapeutic potential of modern small-bowel endoscopy. Gastrointest Endosc. 2007;66:S91–3.CrossRefPubMed
20.
go back to reference Oshitani N, Yukawa T, Yamagami H, Inagawa M, Kamata N, Watanabe K, et al. Evaluation of deep small bowel involvement by double-balloon enteroscopy in Crohn’s disease. Am J Gastroenterol. 2006;101:1484–9.CrossRefPubMed Oshitani N, Yukawa T, Yamagami H, Inagawa M, Kamata N, Watanabe K, et al. Evaluation of deep small bowel involvement by double-balloon enteroscopy in Crohn’s disease. Am J Gastroenterol. 2006;101:1484–9.CrossRefPubMed
21.
go back to reference Mensink PB, Groenen MJ, van Buuren HR, Kuipers EJ, van der Woude CJ. Double-balloon enteroscopy in Crohn’s disease patients suspected of small bowel activity: findings and clinical impact. J Gastroenterol. 2009;44:271–6.CrossRefPubMed Mensink PB, Groenen MJ, van Buuren HR, Kuipers EJ, van der Woude CJ. Double-balloon enteroscopy in Crohn’s disease patients suspected of small bowel activity: findings and clinical impact. J Gastroenterol. 2009;44:271–6.CrossRefPubMed
22.
go back to reference Lee SD, Cohen RD. Endoscopy of the small bowel in inflammatory bowel disease. Gastrointest Endosc Clin N Am. 2002;12:485–93.CrossRefPubMed Lee SD, Cohen RD. Endoscopy of the small bowel in inflammatory bowel disease. Gastrointest Endosc Clin N Am. 2002;12:485–93.CrossRefPubMed
23.
go back to reference Stange EF, Travis SP, Vermeire S, Beglinger C, Kupcinkas L, Geboes K, et al. European evidence based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis. Gut. 2006;55(Suppl 1):i1–15.CrossRefPubMed Stange EF, Travis SP, Vermeire S, Beglinger C, Kupcinkas L, Geboes K, et al. European evidence based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis. Gut. 2006;55(Suppl 1):i1–15.CrossRefPubMed
24.
go back to reference de Dombal FT, Softley A. IOIBD Report No 1: Observer variation in calculating indices of severity and activity in Crohn’s disease. International Organisation for the Study of Inflammatory Bowel Disease. Gut. 1987;28:474–81. de Dombal FT, Softley A. IOIBD Report No 1: Observer variation in calculating indices of severity and activity in Crohn’s disease. International Organisation for the Study of Inflammatory Bowel Disease. Gut. 1987;28:474–81.
25.
go back to reference Fukuda Y, Matsui T, Suzuki Y, Kanke K, Matsumoto T, Takazoe M, et al. Adsorptive granulocyte and monocyte apheresis for refractory Crohn’s disease: an open multicenter prospective study. J Gastroenterol. 2004;39:1158–64.CrossRefPubMed Fukuda Y, Matsui T, Suzuki Y, Kanke K, Matsumoto T, Takazoe M, et al. Adsorptive granulocyte and monocyte apheresis for refractory Crohn’s disease: an open multicenter prospective study. J Gastroenterol. 2004;39:1158–64.CrossRefPubMed
26.
go back to reference May A, Nachbar L, Schneider M, Neumann M, Ell C. Push-and-pull enteroscopy using the double-balloon technique: method of assessing depth of insertion and training of the enteroscopy technique using the Erlangen Endo-Trainer. Endoscopy. 2005;37:66–70.CrossRefPubMed May A, Nachbar L, Schneider M, Neumann M, Ell C. Push-and-pull enteroscopy using the double-balloon technique: method of assessing depth of insertion and training of the enteroscopy technique using the Erlangen Endo-Trainer. Endoscopy. 2005;37:66–70.CrossRefPubMed
27.
go back to reference Aldhous MC, Drummond HE, Anderson N, Baneshi MR, Smith LA, Arnott ID, et al. Smoking habit and load influence age at diagnosis and disease extent in ulcerative colitis. Am J Gastroenterol. 2007;102:589–97.CrossRefPubMed Aldhous MC, Drummond HE, Anderson N, Baneshi MR, Smith LA, Arnott ID, et al. Smoking habit and load influence age at diagnosis and disease extent in ulcerative colitis. Am J Gastroenterol. 2007;102:589–97.CrossRefPubMed
28.
go back to reference Hanauer SB. Clinical perspectives in Crohn’s disease. Turning traditional treatment strategies on their heads: current evidence for “step-up” versus “top-down”. Rev Gastroenterol Disord. 2007;7(Suppl 2):S17–22.PubMed Hanauer SB. Clinical perspectives in Crohn’s disease. Turning traditional treatment strategies on their heads: current evidence for “step-up” versus “top-down”. Rev Gastroenterol Disord. 2007;7(Suppl 2):S17–22.PubMed
29.
go back to reference Efthymiou A, Viazis N, Mantzaris G, Papadimitriou N, Tzourmakliotis D, Raptis S, et al. Does clinical response correlate with mucosal healing in patients with Crohn’s disease of the small bowel? A prospective, case-series study using wireless capsule endoscopy. Inflamm Bowel Dis. 2008;14:1542–7.CrossRefPubMed Efthymiou A, Viazis N, Mantzaris G, Papadimitriou N, Tzourmakliotis D, Raptis S, et al. Does clinical response correlate with mucosal healing in patients with Crohn’s disease of the small bowel? A prospective, case-series study using wireless capsule endoscopy. Inflamm Bowel Dis. 2008;14:1542–7.CrossRefPubMed
30.
go back to reference Fukumoto A, Tanaka S, Yamamoto H, Yao T, Matsui T, Iida M, et al. Diagnosis and treatment of small-bowel stricture by double balloon endoscopy. Gastrointest Endosc. 2007;66:S108–12.CrossRefPubMed Fukumoto A, Tanaka S, Yamamoto H, Yao T, Matsui T, Iida M, et al. Diagnosis and treatment of small-bowel stricture by double balloon endoscopy. Gastrointest Endosc. 2007;66:S108–12.CrossRefPubMed
31.
go back to reference Lichtenstein GR, Olson A, Travers S, Diamond RH, Chen DM, Pritchard ML, et al. Factors associated with the development of intestinal strictures or obstructions in patients with Crohn’s disease. Am J Gastroenterol. 2006;101:1030–8.CrossRefPubMed Lichtenstein GR, Olson A, Travers S, Diamond RH, Chen DM, Pritchard ML, et al. Factors associated with the development of intestinal strictures or obstructions in patients with Crohn’s disease. Am J Gastroenterol. 2006;101:1030–8.CrossRefPubMed
32.
go back to reference Cohen RD, Larson LR, Roth JM, Becker RV, Mummert LL. The cost of hospitalization in Crohn’s disease. Am J Gastroenterol. 2000;95:524–30.CrossRefPubMed Cohen RD, Larson LR, Roth JM, Becker RV, Mummert LL. The cost of hospitalization in Crohn’s disease. Am J Gastroenterol. 2000;95:524–30.CrossRefPubMed
33.
go back to reference Bernstein CN, Nabalamba A. Hospitalization, surgery, and readmission rates of IBD in Canada: a population-based study. Am J Gastroenterol. 2006;101:110–8.CrossRefPubMed Bernstein CN, Nabalamba A. Hospitalization, surgery, and readmission rates of IBD in Canada: a population-based study. Am J Gastroenterol. 2006;101:110–8.CrossRefPubMed
34.
go back to reference Sunada K, Yamamoto H, Kita H, Yano T, Sato H, Hayashi Y, et al. Clinical outcomes of enteroscopy using the double-balloon method for strictures of the small intestine. World J Gastroenterol. 2005;11:1087–9.PubMed Sunada K, Yamamoto H, Kita H, Yano T, Sato H, Hayashi Y, et al. Clinical outcomes of enteroscopy using the double-balloon method for strictures of the small intestine. World J Gastroenterol. 2005;11:1087–9.PubMed
35.
go back to reference Couckuyt H, Gevers AM, Coremans G, Hiele M, Rutgeerts P. Efficacy and safety of hydrostatic balloon dilatation of ileocolonic Crohn’s strictures: a prospective longterm analysis. Gut. 1995;36:577–80.CrossRefPubMed Couckuyt H, Gevers AM, Coremans G, Hiele M, Rutgeerts P. Efficacy and safety of hydrostatic balloon dilatation of ileocolonic Crohn’s strictures: a prospective longterm analysis. Gut. 1995;36:577–80.CrossRefPubMed
36.
go back to reference Sabate JM, Villarejo J, Bouhnik Y, Allez M, Gornet JM, Vahedi K, et al. Hydrostatic balloon dilatation of Crohn’s strictures. Aliment Pharmacol Ther. 2003;18:409–13.CrossRefPubMed Sabate JM, Villarejo J, Bouhnik Y, Allez M, Gornet JM, Vahedi K, et al. Hydrostatic balloon dilatation of Crohn’s strictures. Aliment Pharmacol Ther. 2003;18:409–13.CrossRefPubMed
37.
go back to reference Triester SL, Leighton JA, Leontiadis GI, Gurudu SR, Fleischer DE, Hara AK, et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn’s disease. Am J Gastroenterol. 2006;101:954–64.CrossRefPubMed Triester SL, Leighton JA, Leontiadis GI, Gurudu SR, Fleischer DE, Hara AK, et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn’s disease. Am J Gastroenterol. 2006;101:954–64.CrossRefPubMed
38.
go back to reference Leighton JA, Legnani P, Seidman EG. Role of capsule endoscopy in inflammatory bowel disease: where we are and where we are going. Inflamm Bowel Dis. 2007;13:331–7.CrossRefPubMed Leighton JA, Legnani P, Seidman EG. Role of capsule endoscopy in inflammatory bowel disease: where we are and where we are going. Inflamm Bowel Dis. 2007;13:331–7.CrossRefPubMed
39.
go back to reference Masselli G, Casciani E, Polettini E, Lanciotti S, Bertini L, Gualdi G. Assessment of Crohn’s disease in the small bowel: prospective comparison of magnetic resonance enteroclysis with conventional enteroclysis. Eur Radiol. 2006;16:2817–27.CrossRefPubMed Masselli G, Casciani E, Polettini E, Lanciotti S, Bertini L, Gualdi G. Assessment of Crohn’s disease in the small bowel: prospective comparison of magnetic resonance enteroclysis with conventional enteroclysis. Eur Radiol. 2006;16:2817–27.CrossRefPubMed
40.
go back to reference Gourtsoyiannis NC, Papanikolaou N, Karantanas A. Magnetic resonance imaging evaluation of small intestinal Crohn’s disease. Best Pract Res Clin Gastroenterol. 2006;20:137–56.CrossRefPubMed Gourtsoyiannis NC, Papanikolaou N, Karantanas A. Magnetic resonance imaging evaluation of small intestinal Crohn’s disease. Best Pract Res Clin Gastroenterol. 2006;20:137–56.CrossRefPubMed
41.
go back to reference Gerson L, Kamal A. Cost-effectiveness analysis of management strategies for obscure GI bleeding. Gastrointest Endosc. 2008;68:920–36.CrossRefPubMed Gerson L, Kamal A. Cost-effectiveness analysis of management strategies for obscure GI bleeding. Gastrointest Endosc. 2008;68:920–36.CrossRefPubMed
Metadata
Title
Roles of double-balloon endoscopy in the diagnosis and treatment of Crohn’s disease: a multicenter experience
Authors
Jumpei Kondo
Hideki Iijima
Takashi Abe
Masato Komori
Satoshi Hiyama
Toshifumi Ito
Akihiro Nakama
Kouhei Tominaga
Mitsuhiko Kubo
Kunio Suzuki
Yoshihisa Iwanaga
Ryoichi Ebara
Akira Takeda
Shingo Tsuji
Tsutomu Nishida
Shusaku Tsutsui
Masahiko Tsujii
Norio Hayashi
Publication date
01-07-2010
Publisher
Springer Japan
Published in
Journal of Gastroenterology / Issue 7/2010
Print ISSN: 0944-1174
Electronic ISSN: 1435-5922
DOI
https://doi.org/10.1007/s00535-010-0216-6

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