Background: Since Double Balloon Endoscopy (DBE) enables us to examine deep small bowel either oral or anal it could be of great utility in the management of Crohn's disease (CD) patients. Aim: To evaluate the diagnostic yield and therapeutic impact of DBE on small bowel CD.
Methods: The medical records of 180 CD patients, from October 2009 to April 2015, were retrospectively analyzed. Patients were included if they had known CD based on clinical, colonoscopic and histological findings and had been subjected to DBE. If one patient underwent more than one DBE examination only the first evaluation was considered. The primary end point of our study was to evaluate small bowel involvement that is beyond the reach of conventional colonoscopy. The secondary endpoints were to determine the impact of DBE findings on management strategy of CD. The diagnostic yield of DBE in small bowel CD was determined. In addition, the changes in medical treatment, endoscopic intervention and surgical procedures, within three months after DBE, were analyzed.
Results: Among 180 patients with CD, 90 patients underwent 168 DBE examinations and included. The mean age of included patients was 40±13.6 years. They were 63 males and 27 females. Eighty-two (91%) patients with established CD underwent DBE for evaluation of small bowel involvement and 8 (9%) patients underwent DBE because of suspicion of CD and had been newly diagnosed. The overall diagnostic yield of DBE was 69%. Within 3 months after DBE examination the management strategy of CD changed in 47 (52.2%) patients, based on DBE findings. The medical treatment escalated in 20 (32%) patients, and decreased in 7 (11%). 14 (24%) patients underwent DBE assisted balloon dilatation, and 6 (9.6%) patients underwent CD-related surgery.
Conclusions: DBE is able to uncover small bowel involvement in a significant proportion of CD patients. The DBE findings modified the management strategy in at least one half of CD patients.