The following article is a part of conference coverage from the Advances in Inflammatory Bowel Diseases 2021 Annual Meeting , held from December 9 to 11, 2021. The team at Gastroenterology Advisor will be reporting on the latest news and research conducted by leading experts in gastroenterology. Check back for more from AIBD 2021.
Double balloon enteroscopy (DBE) was found to be effective in extensively diagnosing isolated small bowel Crohn disease (CD), according to study results presented at the Advances in Inflammatory Bowel Diseases (AIBD) 2021 conference, held from December 9 to 11, 2021, in Orlando, Florida and virtually.
Given the nonspecific symptoms and associated challenges in diagnosing isolated small bowel CD, researchers aimed to examine and describe the diagnostic benefits of DBE and its implications in managing patients with known and suspected/rule-out CD.
Investigators conducted a retrospective analysis using data from the Mayo Clinic DBE database from February 2009 to May 2013. Patients referred for DBE for further evaluation of established or suspected CD were included in the analysis. Researchers assessed data on patient demographics, disease characteristics, imaging and capsule endoscopy (CE) findings, pathology findings, history and indications for DBE, DBE findings and adverse effects, treatment before and post-DBE, and follow-up DBE.
A total of 108 patients were included in the study, and 61 were women with a mean age of 52 years. Results showed that 10 patients had indications for DBE based on disease activity/therapeutic assessment, with an established diagnosis of CD. Additionally, 98 patients had indications for DBE for diagnostic purposes, with suspected CD; of these, 31, 29, and 26 patients had abnormal imaging, abnormal CE, and both abnormal imaging and CE, respectively. Areas covered by DBE included upper (n=21), lower (n=24), bidirectional upper and lower (n=62), and stomal (n=1).
Of the 10 patients with an established diagnosis, DBE indicated active disease in 8 patients, with 1 patient undergoing stricture dilation. All the patients were recommended therapeutic changes, which included starting on thiopurine (n=2), optimizing thiopurine dosage (n=1), starting on biologics (n=3), changes in biologics (n=1), systemic steroids (n=1), and budesonide (n=1). One patient undergoing stricture dilation required surgery.
Of the 98 patients with suspected CD, a definitive diagnosis of CD (endoscopic and histologic) was achieved in only 39 (40%) patients — 32 (82%) of these patients were recommended changes in management. A previous diagnosis of CD (outside of Mayo Clinic) was reported in 24/98 patients; of these, only 15/24 (63%) patients were confirmed to have CD.
Reported adverse events included perforation in 1 patient and mouth swelling/abrasion in 3 patients. A total of 10/49 (20%) patients with a definitive diagnosis of CD had follow-up DBE after an average of 4.5 years. Changes in management were recommended for 6 patients. One patient had lymphoma 2.4 years after initial DBE; no other complications were reported at follow-up.
Researchers concluded, “DBE is a useful technique to confirm a diagnosis in patients who have suspected CD and can help establish a diagnosis of several diseases that may mimic CD on [computed tomography] scan or CE. Additionally, DBE in patients with established diagnosis of small bowel CD is an effective tool to assess disease activity and guide therapy. Serious complications are infrequent.”
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Daniela F, Christian K, Jing W et al. Clinical usefulness of double balloon enteroscopy in patients with established or suspected small bowel Crohn’s disease. Presented at: AIBD 2021 Annual Meeting; December 9-11, 2021; Orlando, FL and virtual. Abstract P032.