title: Double-balloon enteroscopy versus magnetic resonance enteroclysis in diagnosing suspected small-bowel Crohn's disease: results of a pilot study.
abstract: OBJECTIVE
  Small-bowel manifestations are common complications in Crohn's disease (CD) but can often be underestimated because of diagnostic limitations. Double-balloon enteroscopy (DBE) is a new endoscopic method that provides complete visualization and biopsy sampling of the small bowel with potential implications for diagnosis and therapy. The purpose of this study was to compare the diagnostic yield of DBE and magnetic resonance enteroclysis (MRE) in patients suspected of having small-bowel CD.
  
  
  METHODS
  Ten patients were consecutively selected and included in the study. In all patients a DBE of the small bowel was performed, the endoscopist being unaware of the radiological findings. Evaluation criteria included the presence of pathology, localization, degree, and extension of affection according to predefined morphologic criteria. Samples for histopathological investigation were taken in all patients with abnormal mucosa.
  
  
  RESULTS
  In 50% of the patients (5 out of 10) with suspected small-bowel CD, DBE revealed pathological results. Here, in four patients, CD was verified histologically. A new diagnosis had to be established in one patient diagnosed for malignant lymphoma. The medical management had to change in five patients. In two patients, both DBE and MRE showed no pathological results; in three patients, superficial lesions were identified by MRE, whereas DBE was normal.
  
  
  CONCLUSIONS
  In selected patients with suspected small-bowel lesions, DBE is a promising tool in the diagnostic work-up and provides the advantage of biopsy sampling. In contrast, non-invasive MRE delivers excellent information about extraluminal pathology associated with CD. Both MRE and DBE have the potential to become diagnostic standards that complement each other in patients with suspected complex small-bowel CD.
authors.affiliation: Department of Internal Medicine II, University of Munich-Grosshadern, Germany. Julia.Seiderer@med.uni-muenchen.de
authors.forename: Julia
authors.initials: J
authors.lastname: Seiderer
authors.forename: Karin
authors.initials: K
authors.lastname: Herrmann
authors.forename: Helmut
authors.initials: H
authors.lastname: Diepolder
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schoenberg
authors.forename: Andreas C
authors.initials: AC
authors.lastname: Wagner
authors.forename: Burkhard
authors.initials: B
authors.lastname: Göke
authors.forename: Thomas
authors.initials: T
authors.lastname: Ochsenkühn
authors.forename: Claus
authors.initials: C
authors.lastname: Schäfer
mesh_terms: D000293:Adolescent; D000328:Adult; D003424:Crohn Disease / Q000175:diagnosis*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000000981:diagnostic imaging* / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011859:Radiography