| Theme |
An algorithm for finding and treatment of small intestinal disease -- DBE and CE |
| Title |
Diagnostic usefulness and limitations of capsule endoscopy and double balloon endoscopy for small bowel pathologies of Crohn's disease |
| Author |
Kenji Watanabe |
Department of Gastroenterology, Osaka City University Graduate School of Medicine |
| Author |
Shuhei Hosomi |
Department of Gastroenterology, Osaka City University Graduate School of Medicine |
| Author |
Naoto Hirata |
Department of Gastroenterology, Osaka City University Graduate School of Medicine |
| Author |
Noriko Kamata |
Department of Gastroenterology, Osaka City University Graduate School of Medicine |
| Author |
Mitsue Sogawa |
Department of Gastroenterology, Osaka City University Graduate School of Medicine |
| Author |
Hirokazu Yamagami |
Department of Gastroenterology, Osaka City University Graduate School of Medicine |
| Author |
Yasuhiro Fujiwara |
Department of Gastroenterology, Osaka City University Graduate School of Medicine |
| Author |
Nobuhide Oshitani |
Department of Gastroenterology, Osaka City University Graduate School of Medicine |
| Author |
Kazuhide Higuchi |
Department of Gastroenterology, Osaka City University Graduate School of Medicine |
| Author |
Tetsuo Arakawa |
Department of Gastroenterology, Osaka City University Graduate School of Medicine |
| [ Summary ] |
Recently, capusule endoscopy (CE) and double balloon endoscopy (DBE) have been refined as enteroscopic tools for the small intestine. CE and DBE were very useful for evaluation of patients with Crohn's disease (CD). The detection of strictures the middle or upper part of the ileum in the small pelvis is difficult but, important for avoidance of CE retention, especially for asymptomatic CD patients. The Agile™ patency capsule is useful in predicting retention. DBE was very useful to see voluntary and take biopsy, perform endoscopic treatments. Attention must be paid perforations, in cases of severe active disease or balloon dilatation, to strictures with active ulcers. Additionally, in cases of anal route insertion for patients with CD, deep insertion of DBE beyond the lower part of the ileum is difficult, due to adhesions or active ulcers with CD in about 40 % of cases. However, about 20 % of main lesion in the small bowel of patients with CD were located in the oral side of the middle of the ileum. Typical CD cases exhibited a transition of endoscopic findings from aphtha to erosion, small ulcers, or longitudinal ulcers, which advanced from the upper side of the jejunum to the terminal ileum. This transition of endoscopic findings was very useful for differential diagnosis of other inflammatory bowel diseases. The detection of mucosal healing will become more important with increased usage of immunomodulators. |