title: Small-bowel obstruction: diagnostic comparison between double-balloon endoscopy and fluoroscopic enteroclysis, and the outcome of enteroscopic treatment.
abstract: BACKGROUND
  Small-bowel obstruction (SBO) sometimes remains undiagnosed and untreatable without surgery.
  
  
  OBJECTIVE
  To evaluate the diagnostic yields of SBO between double-balloon endoscopy (DBE) and fluoroscopic enteroclysis (FE), and the outcome of enteroscopic treatment.
  
  
  METHODS
  Single-center, retrospective, and prospective study.
  
  
  METHODS
  Tertiary-referral hospital.
  
  
  METHODS
  Between June 2003 and July 2007, 66 consecutive patients with SBO were enrolled, investigated, and treated.
  
  
  METHODS
  A comparison of diagnostic yields between DBE and FE, and the prognosis after enteroscopic balloon dilation.
  
  
  RESULTS
  The diagnostic yield of DBE for SBO (95%) was higher than that of FE (71%) in 59 patients who underwent both examinations (P= .004). The first treatment included 27 surgical, 25 enteroscopic, and 14 conservative therapies. Of 47 enteroscopic balloon dilation procedures in 22 patients, 45 (96%) were successful. Of 16 patients with Crohn's disease, 11 (69%) remained asymptomatic over the postdilation follow-up period but 5 relapsed: 2 recovered by repeated dilations, but 3 required surgery. Of 6 patients who had diseases other than Crohn's disease, 4 (67%) remained asymptomatic but 2 relapsed: one with remission of metastasis recovered by repeated dilations, and one with ischemic enteritis required surgery. Anastomotic stricture was an independent marker of the symptom-free outcome (hazard ratio 0.037-0.084, P= .037). Two acute pancreatitis, one perforation, and one exacerbation of SBO complications occurred.
  
  
  CONCLUSIONS
  Small sample size and participation bias.
  
  
  CONCLUSIONS
  DBE was useful for the diagnosis of SBO. Balloon dilation is considered an alternative to surgery in patients with fibrotic strictures both related and unrelated to Crohn's disease.
authors.affiliation: Department of Gastroenterology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan. nohmiya@med.nagoya-u.ac.jp
authors.forename: Naoki
authors.initials: N
authors.lastname: Ohmiya
authors.forename: Daigo
authors.initials: D
authors.lastname: Arakawa
authors.forename: Masanao
authors.initials: M
authors.lastname: Nakamura
authors.forename: Wataru
authors.initials: W
authors.lastname: Honda
authors.forename: Osamu
authors.initials: O
authors.lastname: Shirai
authors.forename: Ayumu
authors.initials: A
authors.lastname: Taguchi
authors.forename: Akihiro
authors.initials: A
authors.lastname: Itoh
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Hirooka
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Niwa
authors.forename: Osamu
authors.initials: O
authors.lastname: Maeda
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ando
authors.forename: Hidemi
authors.initials: H
authors.lastname: Goto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D002404:Catheterization / Q000379:methods; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007415:Intestinal Obstruction / Q000175:diagnosis* / Q000628:therapy; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult