Case studyEffective dilation of small-bowel strictures by double-balloon enteroscopy in patients with symptomatic Crohn's disease (with video)
Section snippets
Materials and methods
DBE was introduced to St. Mark's Hospital in February 2005. Data for patients with CD referred for small-bowel stricture dilation were prospectively collected. Almost all patients presented with obstructive-type symptoms: abdominal pain and bloating with chronic dietary restriction. The following information was recorded: stricture characteristics, route of procedure, dilation success, symptom resolution and change in diet post-dilation, need for repeated dilation, complications, and surgery. A
Results
Overall in the 13 DBE procedures that were performed during the study period (February 2005 to October 2008), 18 small-bowel stricture dilations were performed in 9 of 11 patients. The mean stricture dilation diameter was 15.4 mm (range 12-20 mm). In the 2 patients in whom stricture dilation was not performed, DBE proved to be technically challenging. Adhesions from previous surgery and possibly from underlying CD itself made it impossible to reach the strictures in these patients who
Discussion
Although endoscopic hydrostatic dilation of CD-associated strictures has been used since the late 1980s,18 the technique has been mainly applied to upper GI, ileocolic, or colonic strictures19, 20, 21 because most of the small bowel has remained inaccessible to conventional flexible endoscopy. The ability to reach and dilate strictures deep within the small-bowel endoscopically is now possible with DBE. Our case series adds to the currently small body of published evidence,16 which shows that
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DISCLOSURE: The following author disclosed financial relationships relevant to this publication: E. Despott: research grant, Endoscopy UK/Fujinon. All other authors disclosed no financial relationships relevant to this publication.