Diagnostic and therapeutic yield of double-balloon enteroscopy in small bowel diseases: a prospective cohort study

Abstract Background & aims Diagnosis of small intestinal diseases has long been difficult. Although double-balloon enteroscopy (DBE) is the best method for direct examination of the small bowel, more data are needed to understand and determine which patients will benefit most from the procedure and how DBE directly influence their management and care. Our main aim was to determine the diagnostic and therapeutic yields of DBE. In addition, we evaluated the diagnostic performance of pre-enteroscopy multislice computed tomography (MSCT) in comparison to DBE for diagnosis of different small bowel diseases. Methods We conducted a prospective cohort study of 70 patients at a tertiary care center who were suspected of having small bowel disease, after standard endoscopies had failed to find a cause. All patients underwent laboratory investigations, MSCT and DBE. Results DBE successfully identified a causative lesion in 61.4% of patients (43 out of 70). The most common findings were vascular lesions (32.9%, n = 23) and enteropathy (24.3%, n = 17). We found that patients with lower haemoglobin and lower serum albumin levels were significantly more likely to have a positive DBE result. A total of 56 therapeutic interventions were performed with a 96.4% success rate, which directly resolved the need for blood transfusions in 23 patients. MSCT scans of the abdomen showed overall poor sensitivity (23.3%) compared to DBE, especially for detecting vascular lesions, where its sensitivity was only 8.7%. Conclusion DBE is an effective diagnostic and therapeutic procedure in small bowel diseases. Low haemoglobin and serum albumin levels are factors independently associated with a positive DBE result. DBE is superior to MSCT for diagnosing small intestinal vascular lesions and mucosal inflammation.