Utility of double-balloon enteroscopy for the evaluation of malabsorption.

INTRODUCTION

Occasionally, patients with malabsorption represent a diagnostic challenge. Double-balloon enteroscopy (DBE) allows deep and detailed examination of the small bowel.

AIM

To determine the diagnostic value of DBE in patients with malabsorption of unclear origin.

METHODS

DBE was performed in a total of 12 patients with clinical malabsorption. Biopsy specimens were taken from macroscopic lesions or from examined small bowel at three different levels of scope insertion depth. Tissue specimens were evaluated with standard hematoxylin and eosin, the modified Marsh classification and, when indicated, special stains for amyloidosis.

RESULTS

Fifteen DBEs were successfully performed in 12 patients without complications. DBE with small bowel biopsies yielded a diagnosis in 8 patients (67%). A new diagnosis was reached in 4 patients (33%). The new diagnoses included: Crohn's disease, primary intestinal lymphangiectasia and jejunal amyloidosis. In none of these 4 patients did the duodenal biopsies yield a diagnosis. Also, DBE excluded enteropathy-associated T-cell lymphoma (EATL) and/or ulcerative jejunitis in symptomatic celiac disease patients.

CONCLUSIONS

DBE had a diagnostic value of 42% in patients with malabsorption of unclear origin. In addition, DBE was useful to rule out complications of long-standing celiac disease such as ulcerative jejunitis or EATL. DBE should be reserved for patients with unexplained malabsorption. DBE with jejunal and ileal biopsies appears to have a diagnostic value in patients with malabsorption, even when duodenal biopsies are histologically normal.