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World J Gastrointest Endosc. Oct 16, 2013; 5(10): 476-486
Published online Oct 16, 2013. doi: 10.4253/wjge.v5.i10.476
Enteroscopy in small bowel Crohn’s disease: A review
Benjamin Tharian, Grant Caddy, Tony CK Tham
Benjamin Tharian, Grant Caddy, Tony CK Tham, Division of Gastroenterology, Ulster Hospital, Dundonald BT16 1RH, Belfast, Northern Ireland, United Kingdom
Benjamin Tharian, Gastroenterology and General Medicine North West Area Hospital Service, Tasmania 7307, Australia
Author contributions: Tharian B did the bulk of the literature search and wrote the paper; Caddy G and Tham TCK contributed equally to the literature search, structuring the article, writing the text, review of article and editing the manuscript; all authors approved the final version.
Correspondence to: Benjamin Tharian, MBBS, MD, MRCP, Gastroenterology and General Medicine North West Area Hospital Service, Latrobe TAS, Tasmania 7307, Australia.
Telephone: +61-46-7792969 Fax: +61-36-4265687
Received: May 13, 2013
Revised: July 21, 2013
Accepted: September 4, 2013
Published online: October 16, 2013

Crohn’s disease (CD) is a chronic inflammatory condition of the gastrointestinal tract resulting in inflammation, stricturing and fistulae secondary to transmural inflammation. Diagnosis relies on clinical history, abnormal laboratory parameters, characteristic radiologic and endoscopic changes within the gastrointestinal tract and most importantly a supportive histology. The article is intended mainly for the general gastroenterologist and for other interested physicians. Management of small bowel CD has been suboptimal and limited due to the inaccessibility of the small bowel. Enteroscopy has had a significant renaissance recently, thereby extending the reach of the endoscopist, aiding diagnosis and enabling therapeutic interventions in the small bowel. Radiologic imaging is used as the first line modality to visualise the small bowel. If the clinical suspicion is high, wireless capsule endoscopy (WCE) is used to rule out superficial and early disease, despite the above investigations being normal. This is followed by push enteroscopy or device assisted enteroscopy (DAE) as is appropriate. This approach has been found to be the most cost effective and least invasive. DAE includes balloon-assisted enteroscopy, [double balloon enteroscopy (DBE), single balloon enteroscopy (SBE) and more recently spiral enteroscopy (SE)]. This review is not going to cover the various other indications of enteroscopy, radiological small bowel investigations nor WCE and limited only to enteroscopy in small bowel Crohn’s. These excluded topics already have comprehensive reviews. Evidence available from randomized controlled trials comparing the various modalities is limited and at best regarded as Grade C or D (based on expert opinion). The evidence suggests that all three DAE modalities have comparable insertion depths, diagnostic and therapeutic efficacies and complication rates, though most favour DBE due to higher rates of total enteroscopy. SE is quicker than DBE, but lower complete enteroscopy rates. SBE has quicker procedural times and is evolving but the least available DAE today. Larger prospective randomised controlled trial’s in the future could help us understand some unanswered areas including the role of BAE in small bowel screening and comparative studies between the main types of enteroscopy in small bowel CD.

Keywords: Crohn’s disease, Enteroscopy, Ileoscopy, Balloon-assisted, Device-assisted, Spiral device, Overtube, Stricture, Dilatation

Core tip: Management of small bowel Crohn’s disease has reached new frontiers with the recent renaissance of enteroscopy, that has improved diagnosis and enabled therapeutic interventions. The use of magnetic resonance enteroclysis or wireless capsule endoscopy as the first line modality followed by enteroscopy is the most cost effective. Enteroscopy could be achieved using either a push enteroscope or device-assisted enteroscope (DAE). The latter includes double balloon enteroscopy (DBE), single balloon enteroscopy and more recently spiral enteroscopy. All three DAE modalities are comparable, though most favour DBE due to higher rates of total enteroscopy. The article is intended for the general gastroenterologists, non-gastroenterologists and general practitioners