Clin Endosc.  2017 Sep;50(5):417-423. 10.5946/ce.2017.142.

Balloon-Assisted Enteroscopy and Capsule Endoscopy in Suspected Small Bowel Crohn's Disease

• Yen HH
• Chang CW
• Chou JW
• Wei SC

• KMID: 2394740
• DOI: http://doi.org/10.5946/ce.2017.142

Abstract

Inflammatory bowel diseases are idiopathic inflammatory diseases of two main types, Crohn's disease and ulcerative colitis. Crohn's disease can affect the entire gastrointestinal tract, and the distal ileum is involved in up to 70% of patients. Moreover, Crohn's disease in one-quarter to one-third of patients involves isolation of the small bowel. Due to the nonspecific symptoms and anatomical location of the disease, small bowel Crohn's disease is a phenotype that is particularly difficult to manage. Since the introduction of capsule endoscopy in 2000 and balloon-assisted enteroscopy in the 21st century, it is now possible to directly inspect for small bowel Crohn's disease. However, the new modalities still have limitations, such as capsule retention and invasiveness of balloon-assisted enteroscopy. The diagnostic yields of both capsule endoscopy and balloon-assisted enteroscopy are high for patients with suspected small bowel Crohn's disease. Therefore, earlier use of capsule endoscopy or balloon-assisted enteroscopy can help with the diagnosis and earlier treatment of these patients to avert possible disastrous outcomes.

Keyword

Small bowel Crohn's disease; Balloon-assisted enteroscopy; Capsule endoscopy

MeSH Terms

Capsule Endoscopy*
Colitis, Ulcerative
Crohn Disease*
Diagnosis
Gastrointestinal Tract
Humans
Ileum
Inflammatory Bowel Diseases
Phenotype

Figure

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  Fig. 1. Small bowel Crohn’s disease images captured by capsule endoscopy. (A) Deep ulceration of the jejunum. (B) Ulcerative stenosis of the ileum.

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  Fig. 2. Retention of capsule endoscope and endoscopic retrieval. (A) Capsule endoscopy finding of stenosis of the jejunum. (B) Capsule retention for 2 weeks, revealed by oral-route enteroscopy. (C) Successful retrieval of the retained capsule via enteroscopy

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  Fig. 3. Role of capsule endoscopy in suspected Crohn’s disease proposed by Van de Bruaene et al. [31] CD, Crohn’s disease; MRE, magnetic resonance enterography; CTE, computed tomography enterography.

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  Fig. 4. A 37-year-old man reported chronic abdominal pain for more than 2 years. Abdominal computed tomography revealed (A) swelling of the small bowel wall. (B) Small bowel Crohn’s disease with ulceration and stricture (yellow arrow) was diagnosed via single-balloon enteroscopy

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