Utility of Double Balloon Enteroscopy for the Diagnosis and Management of Crohn’s Disease

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Crohn’s disease (CD) is a chronic inflammatory bowel disease with an unpredictable clinical course and a high incidence of disease recurrence. It can involve any portion of the gastrointestinal tract, but most commonly is found in the distal small bowel and proximal colon. In 30% of patients, the disease is localized only to the small bowel in which case it may be difficult to diagnose. Double balloon enteroscopy (DBE) now enables direct visualization of most, if not the entire small bowel mucosa, and may facilitate the diagnosis of CD. It also allows for biopsies, which can help differentiate CD from other disorders of the small bowel and may be useful in the dilation of strictures. In this chapter, we discuss the use of DBE for the diagnosis and management of CD.

Section snippets

The Role of DBE in the Diagnosis and Long-Term Management of CD

Double balloon enteroscopy (DBE) enables visualization of the entire small bowel and allows for biopsies and therapeutic intervention in areas previously out of reach of push enteroscopy or ileocolonoscopy.22, 23, 24 The technical details of the technique have been previously published and also discussed in preceding chapters of this book.23 Visualization of the entire small bowel can be achieved in up to 86% of cases,22, 23, 24 either by an antegrade approach alone or by a combination of

Summary

Much progress has been made in the ability to examine the small bowel in patients with CD. DBE now enables careful and close examination of most, if not the entire small bowel mucosa. In addition, it allows for biopsies, which can help differentiate CD from other disorders of the small bowel and may be useful in the dilation of strictures. Future studies will need to be done to see if it is a useful technique for monitoring therapy and/or mucosal healing. Finally, it may also prove useful in

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    Financial disclosures: Fujinon: research support (GAD, SFP, JAL); Olympus: research support (JAL); Given Imaging: research support and consulting (JAL).

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