title: Impact of balloon-assisted enteroscopy on the diagnosis and management of suspected and established small-bowel Crohn's disease.
abstract: OBJECTIVE
  The role of recently developed balloon-assisted enteroscopy (BAE) in small-bowel Crohn's disease (CD) is not well established. The purpose of this study is to determine the clinical impact of BAE on patients with suspected and established small-bowel CD.
  
  
  METHODS
  This study included 22 patients (group A) with suspected small-bowel CD and 43 patients (group B) with established small-bowel CD with or without previous surgery, who underwent BAE, in a prospective BAE registry of a US academic medical institution. All underwent abdominal imaging studies including computed tomography (CT) or magnetic resonance (MR) enterography before BAE. The main outcome measurements were diagnostic yield and clinical outcomes.
  
  
  RESULTS
  In total, 78 BAE procedures were carried out in 65 patients. In group A (n = 22, 25 BAE procedures), enteroscopy led to a diagnosis of CD in six patients (27.3 %). Non-steroidal anti-inflammatory drug-related enteropathy was diagnosed in three patients (13.6 %), whereas no lesions were found in the remaining 13 patients. In group B (n = 43, 53 BAE procedures) enteroscopy revealed active intestinal inflammation with ulcers and/or luminal stenosis in 18 patients (41.9 %), which led to a change and escalation of medical therapy. Five patients without active ulcers underwent successful dilation of small-bowel strictures with resulting resolution of obstructive symptoms. Of the 78 BAE procedures, two patients (2.6 %) had bleeding complications which were successfully treated conservatively. One patient (1.3 %) underwent surgery due to procedure-related perforation.
  
  
  CONCLUSIONS
  The use of BAE may help improve management in patients with suspected and established small-bowel CD.
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States.
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States.
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States.
authors.forename: K V Narayanan
authors.initials: KV
authors.lastname: Menon
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States.
authors.forename: Madhusudhan R
authors.initials: MR
authors.lastname: Sanaka
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States.
authors.forename: Chung-Jyi
authors.initials: CJ
authors.lastname: Tsai