Tertiary referral for double balloon enteroscopy in small bowel Crohn's disease: a retrospective assessment of diagnostic impact.

Background: Diagnosing isolated small bowel Crohn's disease (CD) can be challenging, as symptoms, imaging, and capsule endoscopy (CE) can mimic other diseases. Double balloon enteroscopy (DBE) directly evaluates the small bowel. We describe the impact of tertiary referral for DBE in patients with known or suspected small bowel CD. Methods: We carried out a retrospective review of a single tertiary-center DBE database from February 2009 to May 2013. Patients referred for DBE for known or suspected small bowel CD, based on CE, imaging and/or symptoms were included. The primary outcome was the change in diagnosis and/or management after referral for DBE. A descriptive statistical analysis was performed. Results: A total of 108 patients were included, 10 with established CD and 98 with suspected/rule-out CD. DBE changed management in 8/10 patients with known CD. In patients with suspected CD, the diagnosis was confirmed in 39/98 (40%), and management was changed in 32 of those 39 (82%). An alternative diagnosis was made or CD was ruled out in 59/98 (60%) patients with suspected CD. Prior to DBE, starting CD therapy was recommended in 24/98 (25%) patients, but DBE confirmed CD in only 15 of those 24 (63%). Conclusions: Tertiary referral for DBE in suspected CD confined to the small bowel is valuable for investigating the findings from noninvasive testing, such as CE or imaging. DBE can guide CD management and establish accurate diagnoses. Physicians should consider DBE when the diagnosis of isolated small bowel CD is not confirmed by histology.