Diagnosis and treatment of small-bowel stricture by double balloon endoscopy

Background: The source of small-bowel stricture is often difficult to diagnose due to the difficulty, of placing an endoscope into the small bowel. It has recently become possible to examine the entire small bowel and perform balloon dilatation for stricture by means of double balloon endoscopy (DBE). Objective: To identify clinical features of small-bowel stricture and determine the validity of balloon dilatation as a treatment option. Design: Retrospective multicenter study. Setting: Researchers at 7 institutions affiliated with the DBE Working Group. Patients: One hundred seventy-nine patients with stricture among a total of 1035 patients who underwent DBE at the 7 institutions. Interventions: Surgical treatment or balloon dilatation was performed as clinically indicated. Main Outcome Measurements: Ability to detect stricture lesions by DBE, types of lesions, locations of small-bowel strictures, details of strictures, treatments for strictures, and outcomes of balloon dilatation for strictures associated with inflammatory disease. Results: The total number of patients with strictures was 179. Lesions were detected within the small bowel in 156 patients. Inflammatory disease was the most common (n = 87) in patients with small-bowel stricture, and the ileum was the most common site of the inflammatory disease. Crohn's disease was the most common of the inflammatory diseases (n = 57). Balloon dilatations were performed in 31 patients with inflammatory disease, and long-term success was achieved in 22 patients. Limitations: The number of patients treated by balloon dilatation was small. Conclusion: DBE appears to be useful for the detection as well as treatment of small-bowel lesions.