Double-Balloon Endoscopy Effectively Detects Small Bowel Strictures in CD

Double-balloon endoscopy (DBE) can safely and effectively detect small-bowel strictures in patients with Crohn disease (CD), regardless of symptom severity, according to study findings published in BMC Gastroenterology.

Over the last few decades, the advancement of DBE has allowed for more direct visualization of the small intestine and the ability to obtain tissue biopsies and treat strictures. DBE has also become a method for assessing small-bowel CD.

“Small-bowel strictures in CD patients can be difficult to diagnose, particularly in patients with extensive small-bowel involvement,” study authors wrote. “The DBE technique has made examination of the entire small-bowel feasible.”

However, the efficacy of DBE in diagnosing small-bowel strictures in CD compared to other diagnostic methods, such as computed tomography enterography (CTE), is unknown. CTE has demonstrated high efficacy in detection of small-bowel strictures with 83% sensitivity and 88% specificity.

For the analysis, researchers used CTE as a diagnostic comparator to DBE in a single-center hospital cohort. A total of 165 patients with CD presenting with symptoms of small bowel stricture underwent diagnostic assessments with CTE and DBE. The researchers compared the diagnostic yield of DBE to CTE and determined factors that influenced DBE diagnostic efficacy.

Three highly experienced endoscopists detected small bowel strictures in 153 of the 165 patients with CD, resulting in a diagnostic yield of 92.7%. In comparison, the endoscopists detected small bowel strictures in 141 of the 165 patients, resulting in a diagnostic yield of 85.5%.

They also examined the relationship between DBE findings and severity of symptoms.

Severity of each patient’s small bowel stricture symptoms was determined using the Crohn’s Disease Obstructive Score (CDOS) with scores from 1 to 6. The researchers divided the patients into 2 groups according to their CDOS scores — 95 patients who scored between 4 and 6 (high scores) and 70 patients who scored between 1 and 3 (low scores).

The researchers examined DBE diagnostic yields according to symptom severity in the 2 patient subgroups. They found that DBE resulted in a diagnostic yield of 94.7% among the high scoring patients (90 of 95) and 91.4% among the low scoring patients (64 of 70) (P =.13). Given these findings, they concluded that the severity of the stricture did not influence DBE diagnostic yields.

However, other factors independently influenced DBE detection of small-bowel strictures, including a previous history of intra-abdominal abscess or intestinal fistulas (HR, 2.021; 95% CI, 1.075-3.826; P =.021) and a history of CD-associated abdominal surgery (HR, 2.852; 95% CI, 1.146-3.467; P =.017). Scarring from previous surgical procedures, abscesses, or fistulas may make DBE insertion more difficult, thus affecting diagnosis of small-bowel strictures.

“DBE is an efficacious tool for evaluating small-bowel strictures linked with CD, according to our findings,” the study authors wrote. “The diagnostic yield of DBE procedures performed by experienced IBD endoscopists was 92.7%.”

Study limitations include the single-center design at a tertiary care facility and the performance of DBE procedures by only 3 experienced IBD endoscopists, which ultimately may have influenced diagnostic outcomes in this study.