Double-balloon endoscopy versus MR enteroclysis in diagnosing suspected small bowel manifestations in Crohn's disease – results of a pilot study

Aims: Small intestinal manifestations of Crohn's disease (CD) were underestimated regarding their frequency and even their clinical dignity for long. Regarding previous estimations for involvement of the small bowel proximal the terminal ileum ranging between 4% and 65%. This was mainly caused by diagnostic limitations when trying to study the small intestine. It is evident from a clinical perspective with strictures and inflammatory mucosal swelling having in mind that an accurate localization of such complications would be of good help. Double-balloon endoscopy (DBE) is a new method allowing complete visualisation and biopsy sampling of the small bowel. Recent studies in patients with obscure gastrointestinal bleeding have shown that DBE is a promising and safe diagnostic and therapeutic tool. The aim of this pilot study therefore was to compare the diagnostic yield of DBE and magnetic resonance enteroclysis (MRE) in CD patients with suspected small bowel pathology.

Patients and methods: Between August 2005 and January 2006, 6 patients were selected consecutively because of Crohn's disease with suspected small bowel lesions exclusive proximal to the terminal ileum diagnosed in MRE. These patients underwent further endoscopic evaluation of the small bowel using anterograde DBE with the performing endoscopist being unaware of the radiological findings. Criteria for evaluation were the presence of pathology, localisation and degree and extension of affection. Biopsies for histopathological investigations were taken in all patients.

Results: In five of the six patients with suspected CD of the small bowel, DBE revealed pathological results. Here, in four patients Crohn's disease could be verified histological, whereas in one patient a malignant lymphoma was found. The DBE was well tolerated and no complication or relevant technical problems were found in all patients studied.

Conclusions: DBE represents a promising diagnostic tool in suspected CD of the small bowel providing the advantage of biopsy sampling, which might have implications for therapeutic management. Both MRE and DBE might be future criterion standards in CD patients in whom complex small bowel pathology is suspected.