Double-balloon enteroscopy for the evaluation of symptomatic small bowel stricture in Crohn’s disease

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1. Double-balloon enteroscopy (DBE) has a high diagnostic yield for small-bowel strictures in Crohn’s disease (CD) patients, with no difference in accuracy depending on low or high symptom severity.

Evidence Rating Level: 2 (Good)

Strictures occur in an estimated 15-30% of Crohn’s Disease (CD) patients within the first 10 years after diagnosis. Several methods have been developed for evaluating small-bowel strictures, including computed tomography enterography (CTE) and double-balloon enteroscopy (DBE). CTE is very effective at detecting small-bowel disease, with a sensitivity and specificity of 83% and 88% respectively. Meanwhile, DBE has the benefit of allowing direct visualization while obtaining biopsies for histopathologic analysis. However, the relationship between symptom severity and the strictures detected through DBE is unknown. Therefore, this prospective cohort study aimed to determine the detection rate of DBE for CD patients with small-bowel symptomatic strictures. The study participants were enrolled from a single centre in China. All received both CTE and DBE, within one month of each other. The symptom severity was assessed through the Crohn’s Disease Obstructive Score (CDOS), with patients divided into low severity (scores 1-3) and high severity (scores 4-6). In total, there were 165 CD patients included, 42.4% of whom had low severity symptoms. The study found that detection rates of 92.7% and 85.5% through DBE and CTE respectively. For DBE, the rates were 91.4% and 94.7% in the low severity and high severity groups respectively (p = 0.13), whereas for CTE, the detection rate was greater in the high severity than the low severity group (90.1% and 75.9% respectively, p = 0.01). Overall, this study demonstrated that DBE is a very effective method for diagnosing small-bowel strictures in CD patients, with no difference depending on symptom severity.

Click to read the study in BMC Gastroenterology

Image: PD

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