Usefulness of single-balloon enteroscopy in pediatric Crohn's disease

doi:10.1016/j.gie.2011.06.021

Gastrointestinal Endoscopy

Volume 75, Issue 1, January 2012, Pages 80-86

https://doi.org/10.1016/j.gie.2011.06.021 Get rights and content

Background

Single-balloon enteroscopy (SBE) has not been reported in pediatric Crohn's disease (CD).

Objective

To determine technical performance, yield, safety, and clinical impact of SBE in pediatric patients with suspected and established CD.

Design

Prospective, cohort study.

Setting

Academic tertiary-care referral center.

Patients

This study involved 16 patients (group A) with suspected CD and unspecific upper and lower GI endoscopy results and 14 patients (group B) with longstanding CD with previous surgery and showing signs unaccountable by conventional endoscopy. All underwent magnetic resonance imaging, and 14 patients in group A also underwent wireless capsule endoscopy.

Intervention

SBE.

Main Outcome Measurements

SBE diagnostic and therapeutic yield, technical performance, clinical impact, and safety.

Results

In group A, SBE aided diagnosis of CD in 12 patients and eosinophilic enteropathy in 2 patients, whereas no lesions were found in 2 patients. WCE was diagnostic of CD in 3 patients, suggestive of CD in 7 patients, and unspecific in the remaining patients. In group B, SBE revealed moderate-to-severe disease activity in most patients, leading to the introduction of or change in biological therapy, with a marked decrease in the pediatric Crohn's disease activity index scores. SBE allowed successful dilation of small-bowel strictures in 2 patients in group A and 3 in group B. No complications occurred.

Limitations

Small sample size, no direct comparison with imaging or other endoscopic techniques.

Conclusion

SBE is a useful and safe endoscopic procedure for evaluating the small bowel in pediatric patients with suspected or established CD. Not only does it allow a definite diagnosis of CD when the latter is uncertain, but it is also very effective in the management of small-bowel strictures, thus avoiding surgery. It may be helpful in redirecting therapy in selected CD patients.

Section snippets

Materials and methods

Between September 2008 and January 2010, 36 SBEs were performed in 30 pediatric patients (17 male; median age 13 years, range 7-18 years) with suspected or established Crohn's disease. Small-bowel evaluation was needed to (1) achieve a definite diagnosis in patients with symptoms and signs suggesting Crohn's disease but with uncertain results from traditional endoscopy (upper endoscopy, ileocolonoscopy, and WCE) and imaging tool methods, (2) confirm and treat a small-bowel stricture visualized

Group A

Conventional endoscopic features and details on SBE procedures are reported in Table 1. As shown in Figure 3, WCE features were judged as diagnostic in 3 cases, suggestive of Crohn's disease in 7 cases, and unspecific in 4 cases. WCE was not performed in 2 patients with strictures at MRI. The latter revealed increased wall thickness and post-contrast enhancement in 11 patients, whereas no abnormalities were detected in 3 patients. There were no complications in all procedures.

After SBE and

Discussion

Capsule and balloon-assisted enteroscopy improved endoscopic evaluation of the small bowel, with consequent implications in inflammatory bowel disease diagnosis and management.²⁶ However, the majority of patients with inflammatory bowel disease do not require small-bowel endoscopy, because conventional upper and lower intestinal endoscopy allows a definite diagnosis of Crohn's disease and its differentiation from ulcerative colitis.17, 18, 25, 26 Small-bowel endoscopy can be indicated for

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Cited by (44)

Diagnostic yield and technical performance of the novel motorized spiral enteroscopy compared with single-balloon enteroscopy in suspected Crohn's disease: a prospective study (with video)
2023, Gastrointestinal Endoscopy
Both single-balloon enteroscopy (SBE) and the novel motorized spiral enteroscopy (NMSE) are effective techniques for device-assisted enteroscopy (DAE). To date, no study has prospectively compared both modalities in suspected Crohn’s disease (CD).
Patients with suspected CD undergoing either SBE or NMSE between March 2021 and December 2021 in a high-volume tertiary center were prospectively compared for technical success (ability to reach the lesion), diagnostic yield, depth of maximal insertion (DMI), procedure time, and total enteroscopy rates.
One hundred seventy-seven patients (37.2% female; aged 7-75 years) with suspected CD underwent 201 DAEs. Technical success was 83% (SBE 81.5% vs NMSE 87.3%, P = .61) and impacted subsequent management in 92% (SBE 88.5% vs NMSE 97.8%, P = .2). Technical success with antegrade NMSE was significantly higher (81.4%) than antegrade SBE (33.3%, P = .007) for lesions in the proximal ileum and beyond. There was no significant difference in the diagnostic yield (SBE 80.8% vs NMSE 83.6%, P = .65). Median procedure time was significantly lower in both antegrade (NMSE, 40 minutes [range, 10-75]; SBE, 60 minutes [range, 20-180]; P < .0001) and retrograde (NMSE, 25 minutes [range, 20-60]; SBE, 60 minutes [range, 20-180]; P < .0001) NMSE. Median DMI was higher with antegrade NMSE (NMSE, 400 cm [range, 70-600]; SBE, 180 cm [range, 60-430]; P < .0001). The total enteroscopy rate was higher with NMSE (37% vs .7% with SBE, P < .0001). All adverse events were mild.
Both NMSE and SBE are safe and effective for small-bowel evaluation in suspected CD. NMSE is superior to SBE with regard to deeper small-bowel evaluation with complete small-bowel coverage and shorter procedure time.
Single balloon enteroscopy in children for evaluation of small bowel diseases in children: A large, tertiary center study
2021, Journal of Pediatric Surgery
Citation Excerpt :
Of note, majority of these studies utilized DBE for the evaluation of small bowel and the diagnostic performance of SBE is largely unknown in children. Several small studies have reported the safety and feasibility of SBE in pediatric Crohn's disease [12,13]. Our results suggest that SBE has a substantial impact on diagnosis and management of various diseases involving small bowel in children akin to DBE.
Device assisted enteroscopy is the cornerstone for small bowel evaluation. However, the data are limited in pediatric patients. In this study, we aim to evaluate the safety and utility of single balloon enteroscopy (SBE) in children.
The data of children (≤18-years) who underwent SBE from November 2010 to July 2020 was analyzed, retrospectively. The safety and diagnostic yield of SBE were assessed.
189-SBE procedures (males 117, mean age 15.1 ± 2.76, range 3–18 years) were performed in 174-children. The indications for SBE were chronic abdominal pain in 119 (68.4%), gastrointestinal bleed 17 (9.8%), chronic diarrhea 17 (9.8%) and vomiting 13 (7.5%). Antegrade, retrograde and combined SBE were performed in 98 (51.8%), 77 (40.7%), 7 (3.7%) children, respectively. The mean length of small bowel intubation in antegrade and retrograde SBE groups were 168.9 ± 58.6 cm and 120.7 ± 52.1 cm, respectively. Overall, a positive finding was seen in 117 (67.2%) cases. The most common findings were ileal and jejunal ulcers with or without strictures in 76 (64.9%) children. A total of 18 therapeutic enteroscopic procedures were performed. There were no major adverse events.
SBE is a safe and effective procedure for the evaluation and management of small bowel diseases in children.
Capsule Endoscopy and Small Bowel Enteroscopy
2020, Pediatric Gastrointestinal and Liver Disease, Sixth Edition
Crohn Disease
2020, Pediatric Gastrointestinal and Liver Disease, Sixth Edition
This chapter focuses upon the clinical presentation, diagnostic approach, and advanced treatment strategies for children diagnosed with Crohn disease. The pediatric IBD community continues to make great progress in the evaluation and management of this complex patient group. New therapies are being developed and therapy optimization continues to improve. Optimal management requires care delivered by experienced, multidisciplinary teams focused upon comprehensive care, quality improvement, and care standardization. Advancements in research/clinical trials are ongoing and promise to continue to improve outcomes for children with Crohn disease.
Endoscopic Evaluation of Surgically Altered Bowel in Patients With Inflammatory Bowel Diseases
2018, Interventional Inflammatory Bowel Disease: Endoscopic Management and Treatment of Complications
Treatment of patients with medically refractory inflammatory bowel diseases (IBDs) or colitis-associated neoplasia often requires surgical intervention. Various surgery modalities have been performed. The commonly performed surgery for Crohn's disease includes bowel resection and anastomosis, stricturoplasty, fecal diversion with stoma, while the main surgery for ulcerative colitis is restorative proctocolectomy with ileal pouch-anal anastomosis. Endoscopic evaluation of the surgically altered bowel is needed to assess disease activity and deliver possible therapy. The endoscopist should be familiar with bowel anatomy and identify the landmarks before and during the endoscopic procedures. The stricture and fistula in patients with altered bowel anatomy often pose unique challenges for endoscopic therapy.
Diagnosis and treatment of inflammatory bowel disease: First Latin American Consensus of the Pan American Crohn's and Colitis Organisation
2017, Revista de Gastroenterologia de Mexico
La incidencia y la prevalencia de la enfermedad inflamatoria intestinal (EII) se han incrementado en los últimos años en varios países de Latinoamérica. Existe una necesidad de concientizar a gastroenterólogos y a la población en general para poder tener un diagnóstico y tratamiento oportunos en la colitis ulcerosa crónica idiopática (CUCI) y enfermedad de Crohn (EC). Es importante que todos los médicos tengan un criterio homogéneo acerca del diagnóstico y el tratamiento de la EII en América Latina. La Pan American Crohn's and Colitis Organisation (PANCCO) es un organismo con el propósito de incluir a todos los países del continente americano pero se enfoca de manera específica a los países latinos. Este Consenso está dividido en 2 partes para su publicación: 1) diagnóstico y tratamiento, y 2) situaciones especiales.
Este es el primer Consenso latinoamericano cuyo objetivo es promover una perspectiva adaptada a nuestros países latinos para el diagnóstico, el tratamiento y la monitorización de pacientes con CUCI y EC.
The incidence and prevalence of inflammatory bowel disease (IBD) has increased in recent years in several Latin American countries. There is a need to raise awareness in gastroenterologists and the population in general, so that early diagnosis and treatment of ulcerative colitis (UC) and Crohn's Disease (CD) can be carried out. It is important for all physicians to have homogeneous criteria regarding the diagnosis and treatment of IBD in Latin America. The Pan American Crohn's and Colitis Organisation (PANCCO) is an organization that aims to include all the countries of the Americas, but it specifically concentrates on Latin America. The present Consensus was divided into two parts for publication: 1) Diagnosis and treatment and 2) Special situations.
This is the first Latin American Consensus whose purpose is to promote a perspective adapted to our Latin American countries for the diagnosis, treatment, and monitoring of patients with UC and CD.

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: DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

^⁎: Drs Di Nardo and Oliva contributed equally to this article.

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Original articleClinical endoscopyUsefulness of single-balloon enteroscopy in pediatric Crohn's disease

Background

Objective

Design

Setting

Patients

Intervention

Main Outcome Measurements

Results

Limitations

Conclusion

Section snippets

Materials and methods

Group A

Discussion

Lancet

Gastroenterology

Gastrointest Endosc Clin N Am

Gastrointest Endoscopy Clin N Am

Clin Gastroenterol Hepatol

Gastrointest Endosc

Clin Gastroenterol Hepatol

Gastrointest Endosc

Eur J Radiol

Clin Gastroenterol Hepatol

Med Clin N Am

Clin Gastroenterol Hepatol

Pediatric inflammatory bowel disease: highlighting pediatric differences in IBD

Med Clin N Am

Rising incidence of inflammatory bowel disease among children: a 12-year study

J Ped Gastroenterol Nutr

Prospective assessment of the diagnostic and therapeutic impact of small bowel push enteroscopy

Endoscopy

Original article
Clinical endoscopy
Usefulness of single-balloon enteroscopy in pediatric Crohn's disease