title: Double-balloon enteroscopy in the diagnosis of suspected isolated Crohn's disease of the small bowel.
abstract: OBJECTIVE
  Diagnosis of Crohn's disease (CD) with isolated involvement of the small bowel remains a major challenge. Diagnostic procedures allowing direct insight into the midgut have become available with the introduction of double-balloon enteroscopy (DBE) and video-capsule endoscopy (VCE). The aim of the present study was to evaluate the role of DBE in the diagnosis of isolated CD of the small bowel.
  
  
  METHODS
  Sixteen patients (seven males) with suspected CD of the small bowel after exclusion of abnormal changes in the upper gastrointestinal tract and colon by esophagogastroduodenoscopy and colonoscopy including histology underwent DBE and high-resolution transabdominal ultrasound.
  
  
  RESULTS
  In seven of 16 (44%) patients, abnormal macroscopic findings were detected by DBE (e.g. ileitis terminalis, inflammatory stenosis, aphthous lesions or jejunal ulcers). In one of thecases, histology confirmed pathognomonic findings consistent with CD. However, the diagnosis of CD was confirmed in 11/16 (69%) patients taking into account the clinical presentation and course of the disease as well as the endoscopic and imaging results.
  
  
  CONCLUSIONS
  In cases of CD with clinical expression limited to the small bowel, DBE is a helpful tool. Nevertheless, in these patients, the combination of clinical findings and additional imaging modalities is required for confirmation of the diagnosis. A suggestive medical history, high-resolution ultrasound, EGD and colonoscopy lead the algorithm before the assessment with DBE.
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schulz
authors.forename: Klaus
authors.initials: K
authors.lastname: Mönkemüller
authors.forename: Maxi
authors.initials: M
authors.lastname: Salheiser
authors.forename: Michael
authors.initials: M
authors.lastname: Bellutti
authors.forename: Kerstin
authors.initials: K
authors.lastname: Schütte
authors.forename: Peter
authors.initials: P
authors.lastname: Malfertheiner
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003424:Crohn Disease / Q000175:diagnosis*; D003937:Diagnosis, Differential; D058582:Double-Balloon Enteroscopy / Q000379:methods*; D004751:Enteritis / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007079:Ileitis / Q000175:diagnosis*; D007082:Ileum / Q000473:pathology*; D007413:Intestinal Mucosa / Q000473:pathology*; D007579:Jejunal Diseases / Q000175:diagnosis*; D007583:Jejunum / Q000473:pathology; D008297:Male; D008875:Middle Aged
keywords: Crohn's disease (CD); double-balloon enteroscopy; small bowel