title: Double-balloon enteroscopy in Crohn's disease: findings and impact on management in a multicenter retrospective study.
abstract: BACKGROUND
  Double-balloon enteroscopy (DBE) is effective in visualizing the small bowel to perform biopsy sampling and interventions. Few studies have evaluated the utility of DBE in patients with known or suspected Crohn's disease (CD).
  
  
  OBJECTIVE
  To evaluate the use of DBE in the diagnosis and impact on patient management in known and suspected CD and to compare capsule endoscopy (CE) with DBE findings.
  
  
  METHODS
  Retrospective study from August 2004 to August 2009 of DBE procedures.
  
  
  METHODS
  Five academic, tertiary U.S. centers.
  
  
  METHODS
  Patients with known or suspected CD.
  
  
  METHODS
  Diagnostic yield, impact on patient management, and comparison of DBE to CE findings in patients with known and suspected CD.
  
  
  RESULTS
  We analyzed 98 DBE procedures performed in 81 patients (38 with known CD and 43 with suspected CD). For patients with CD, common indications were abdominal pain and bleeding/anemia. The diagnostic yield was 87% (33/38 patients). The impact on subsequent management decisions was 82% (31/38). Common indications for DBE in patients with suspected CD were abnormal CE or other imaging. The diagnostic yield was 79% (34/43 patients). The impact on subsequent management decisions was 77% (33/43). In 17% of patients (14/81), DBE failed to reach the target lesion. There was 1 perforation, 3 strictures dilated, and 1 of 2 retained capsules recovered. When CE was followed by DBE, 46% of lesions were confirmed on DBE.
  
  
  CONCLUSIONS
  Retrospective analysis, imperfect criterion standard.
  
  
  CONCLUSIONS
  DBE is an effective technique for assessment of the small bowel in known and suspected CD and affects management. Failure to reach target areas with DBE is not uncommon, and perforations can occur. There is poor correlation between CE and DBE.
authors.affiliation: Division of Gastroenterology, The University of Western Ontario, London, Ontario, Canada.
authors.forename: Adam
authors.initials: A
authors.lastname: Rahman
authors.affiliation: Division of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ross
authors.affiliation: Division of Gastroenterology, Mayo Clinic, Scottsdale, Arizona, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Leighton
authors.affiliation: Division of Gastroenterology, Virginia Mason Medical Center, Seattle, Washington, USA.
authors.forename: Drew
authors.initials: D
authors.lastname: Schembre
authors.affiliation: Division of Gastroenterology, California Pacific Medical Center, Stanford, California, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Gerson
authors.affiliation: Division of Gastroenterology, Cedars Sinai, Los Angeles, California, USA.
authors.forename: Simon K
authors.initials: SK
authors.lastname: Lo
authors.affiliation: Division of Gastroenterology, University of Chicago Medical Center, Chicago, Illinois, USA.
authors.forename: Irving
authors.initials: I
authors.lastname: Waxman
authors.affiliation: Division of Gastroenterology, Penn State Hershey Medical Center, Hershey, Pennsylvania.
authors.forename: Charles
authors.initials: C
authors.lastname: Dye
authors.affiliation: Division of Gastroenterology, University of Chicago Medical Center, Chicago, Illinois, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Semrad
mesh_terms: D000293:Adolescent; D000328:Adult; D053704:Capsule Endoscopy; D002648:Child; D003424:Crohn Disease / Q000175:diagnosis*; D058582:Double-Balloon Enteroscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult