title: Endoscopic ultrasound with double-balloon endoscopy in the evaluation of small-bowel disease.
abstract: BACKGROUND
  Double-balloon endoscopy (DBE) has become a new standard in enteroscopy. However, it may be difficult to make a diagnosis or plan treatment strategy with endoscopic visualization alone. The addition of endoscopic ultrasonography (EUS) has the potential to improve the ability to establish the diagnosis and develop a treatment strategy. The present study was conducted to assess the feasibility and usefulness of EUS with DBE.
  
  
  METHODS
  EUS with DBE was performed in 31 of 891 patients who underwent DBE from July 2004 to March 2011 at Jichi Medical University Hospital. We analyzed the EUS findings for lesions and evaluated the usefulness of EUS considering the following three factors: qualitative diagnostic value for lesions, depth grading of lesions, and evaluation of the structure of severe strictures prior to endoscopic balloon dilation.
  
  
  RESULTS
  EUS was performed for 31/32 lesions (97%) in 31 patients. EUS findings were informative for 29/32 lesions (91%). EUS findings were useful for establishing a qualitative diagnosis in 15/25 lesions (60%). EUS findings for depth grading provided useful information for determining the therapeutic strategy in 11/13 lesions (85%). EUS with DBE was useful in the evaluation of strictures for all six lesions (100%). The overall usefulness of EUS with DBE on decision making was 72% (23/32) in this study.
  
  
  CONCLUSIONS
  EUS with DBE is feasible and useful. It provides additional information on small-bowel disease and contributes to establishing a precise diagnosis and selection of an appropriate therapeutic strategy.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Wada
authors.forename: Alan T
authors.initials: AT
authors.lastname: Lefor
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Mutoh
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yano
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Keijiro
authors.initials: K
authors.lastname: Sunada
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Nishimura
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Miura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sato
authors.forename: Hakuei
authors.initials: H
authors.lastname: Shinhata
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sugano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003251:Constriction, Pathologic / Q000175:diagnosis; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D019160:Endosonography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis*; D007421:Intestine, Small / Q000000981:diagnostic imaging* / Q000473:pathology*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D014741:Video Recording