Small-bowel obstruction: diagnostic comparison between double-balloon endoscopy and fluoroscopic enteroclysis, and the outcome of enteroscopic treatment.
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.
Ohmiya
Naoki
N
Department of Gastroenterology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan. nohmiya@med.nagoya-u.ac.jp
Arakawa
Daigo
D
Nakamura
Masanao
M
Honda
Wataru
W
Shirai
Osamu
O
Taguchi
Ayumu
A
Itoh
Akihiro
A
Hirooka
Yoshiki
Y
Niwa
Yasumasa
Y
Maeda
Osamu
O
Ando
Takafumi
T
Goto
Hidemi
H
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