Small-bowel obstruction: diagnostic comparison between double-balloon endoscopy and fluoroscopic enteroclysis, and the outcome of enteroscopic treatment.

BACKGROUND

Small-bowel obstruction (SBO) sometimes remains undiagnosed and untreatable without surgery.

OBJECTIVE

To evaluate the diagnostic yields of SBO between double-balloon endoscopy (DBE) and fluoroscopic enteroclysis (FE), and the outcome of enteroscopic treatment.

DESIGN

Single-center, retrospective, and prospective study.

SETTING

Tertiary-referral hospital.

PATIENTS

Between June 2003 and July 2007, 66 consecutive patients with SBO were enrolled, investigated, and treated.

MAIN OUTCOME MEASUREMENTS

A comparison of diagnostic yields between DBE and FE, and the prognosis after enteroscopic balloon dilation.

RESULTS

The diagnostic yield of DBE for SBO (95%) was higher than that of FE (71%) in 59 patients who underwent both examinations (P= .004). The first treatment included 27 surgical, 25 enteroscopic, and 14 conservative therapies. Of 47 enteroscopic balloon dilation procedures in 22 patients, 45 (96%) were successful. Of 16 patients with Crohn's disease, 11 (69%) remained asymptomatic over the postdilation follow-up period but 5 relapsed: 2 recovered by repeated dilations, but 3 required surgery. Of 6 patients who had diseases other than Crohn's disease, 4 (67%) remained asymptomatic but 2 relapsed: one with remission of metastasis recovered by repeated dilations, and one with ischemic enteritis required surgery. Anastomotic stricture was an independent marker of the symptom-free outcome (hazard ratio 0.037-0.084, P= .037). Two acute pancreatitis, one perforation, and one exacerbation of SBO complications occurred.

LIMITATIONS

Small sample size and participation bias.

CONCLUSIONS

DBE was useful for the diagnosis of SBO. Balloon dilation is considered an alternative to surgery in patients with fibrotic strictures both related and unrelated to Crohn's disease.