Objective. It is estimated that 10%30% of Crohn's disease (CD) patients have small-bowel lesions, but the exact frequency and clinical relevance of these findings are unknown. Double-balloon enteroscopy (DBE) enables endoscopic visualization of the small bowel. The aim of this study was to evaluate the use of DBE for detecting small-bowel lesions in CD patients suspected of having small-bowel involvement. Furthermore, the clinical impact of adjusting treatment in these patients was assessed. Material and methods. A prospective study was performed in a tertiary referral center. CD patients suspected of small-bowel involvement and in whom distal activity had previously been excluded were included. All patients underwent DBE, followed by step-up therapy in patients with small-bowel lesions. The presence of small-bowel lesions during DBE was noted and clinical outcome was assessed after adjusting therapy. Results. Thirty-five patients (70%) showed small-bowel lesions; these lesions could not be assessed by conventional endoscopy in 23 (46%). At 1-year follow-up, step-up therapy in 26 patients (74%) led to clinical remission in 23 (88%). This was confirmed by a significant decrease in Crohn's disease activity index and mucosal repair on second DBE. Conclusions. DBE showed a high frequency of small-bowel lesions in known CD patients with clinically suspected small-bowel activity. Most of these lesions were not accessible for conventional endoscopy. Adjusting treatment in patients with small-bowel CD involvement led to clinical remission and mucosal repair in the majority of cases.

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Keywords Crohn's disease, Double-balloon enteroscopy, Enteroscopy, Small bowel, Small-bowel lesions
Persistent URL dx.doi.org/10.3109/00365520903563774, hdl.handle.net/1765/27612
Mensink, P.B.F, Aktas, H, Zelinkova, Z, West, R.L, Kuipers, E.J, & van der Woude, C.J. (2010). Impact of double-balloon enteroscopy findings on the management of Crohn's disease. Scandinavian Journal of Gastroenterology, 45(4), 483–489. doi:10.3109/00365520903563774