Amaç: Çift balonlu enteroskopi (ÇBE) yönteminin, Crohn hastalığı (CH) tanısı veya şüphesi olan hasta grubunda, hastalığın tanı ve tedavisindeki etkinliğinin ve güvenliliğinin değerlendirilmesidir. Gereç ve Yöntemler: Ocak 2008-Aralık 2015 tarihleri arasında, üniversitemiz gastroenteroloji bilim dalında ÇBE işlemi yapılan hastaların dosya ve bilgi kartları geriye dönük olarak incelendi. CH şüphesi veya CH tanısı olup ÇBE işlemi yapılmış olan hastalar ile farklı endikasyonlarda yapılan ÇBE işlemleri sonrasında CH tanısı konulan hastalar çalışmaya dâhil edildi. Bulgular: Altı yüz elli sekiz (405 erkek; ortalama yaş 57,9±11,6) hastaya toplam 936 ÇBE işlemi yapılmıştı. İşlem yapılan hastaların 440 (%66,9)'ında patolojik bulgu tespit edildi. ÇBE yapılması için en sık endikasyon, obskür gastrointestinal sistem kanaması (%41,3) idi. CH endikasyonuyla enteroskopi yapılmış hasta oranı %13,2 iken, CH şüphesi nedeni ile ÇBE işlemi yapılma oranının %8,4 olduğu görüldü. CH şüphesi ile ÇBE yapılan 55 hastanın 31'inde bu tanı doğrulanırken, tanısı bilinen 32 hastanın 9'unda yeni darlık alanı bulunduğu ve 11'inde ise hastalığın yayılımının arttığı görüldü. Farklı endikasyonlarla yapılan ÇBE işlemlerinde toplam 27 hastaya yeni CH tanısı konuldu. Yeni bulgu tespit edilen CH tanılı hastalar da değerlendirmeye katıldığında, ÇBE işleminin tanısal katkısı %11,9 (78/658) oldu. Sonuç: ÇBE işlemleri esnasında, özellikle histolojik tanı desteği sayesinde birçok hastada kesinleşmiş CH tanısı konulması mümkün olmaktadır. Klinik, radyolojik ve biyoşimik göstergelerin kılavuzluğunda kullanılması, ÇBE'nin tanı oranının artırılması için en doğru yöntem gibi gözükmektedir. Bu uygulama, deneyimli eller tarafından gerçekleştirildiğinde son derece emniyetlidir.
Anahtar Kelimeler: Çift balonlu endoskopi; enteroskopi; çift balonlu enteroskopi; Crohn hastalığı
Objective: To evaluate the efficacy and safety of double balloon enteroscopy (DBE) method in the diagnosis and treatment of patients with known or suspicion Crohn's disease (CD). Material and Methods: Between January 2008-December 2015, data cards of patients who underwent DBE procedures in gastroenterology department of our university were examined retrospectively. Patients with suspected or known CD who underwent DBE procedure and patients diagnosed with CD after DBE procedures for different indications were included in the study. Results: A total of 936 DBEs were performed in 658 patients (405 men; mean age 57.9±11.6). The pathological findings were detected in 440 (66.9%) patients. The most common indication for DBE was obscure gastrointestinal bleeding (41.3%). The rate of patients who underwent enteroscopy with the indication of CD was 13.2%, whereas the rate of DBE procedure was 8.4% due to suspected CD. This diagnosis was confirmed in 31 of 55 patients who underwent DBE with the suspicion of CD. A total of 27 patients were diagnosed with new CD in DBE procedures with different indications. The diagnostic contribution of the DBE procedure was 11.9% (78/658) when included of patients with known CD who have been detected new findings. Conclusion: The definitive diagnosis of CD is possible in many patients during DBE procedures especially with the support of histology. Use of DBE guided by clinical, radiological, and biochemical indicators appears to be the most accurate way to increase the diagnostic rate of DBE. Procedure is highly safe, when performed by experienced hands.
Keywords: Double baloon endoscopy; enteroscopy; double balloon enteroscopy; Crohn's disease
- Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology. 2004;126(6):1504-17. [Crossref] [PubMed]
- Cosnes J, Cattan S, Blain A, Beaugerie L, Carbonnel F, Parc R, et al. Long-term evolution of disease behavior of Crohn's disease. Inflamm Bowel Dis. 2002;8(4):244-50. [Crossref] [PubMed]
- Steinhardt HJ, Loeschke K, Kasper H, Holtermüller KH, Schäfer H. European Cooperative Crohn's Disease Study (ECCDS): clinical features and natural history. Digestion. 1985;31(2-3):97-108. [Crossref] [PubMed]
- Voderholzer WA, Beinhoelzl J, Rogalla P, Murrer S, Schachschal G, Lochs H, et al. Small bowel involvement in Crohn's disease: a prospective comparison of wireless capsule endoscopy and computed tomography enteroclysis. Gut. 2005;54(3):369-73. [Crossref] [PubMed] [PMC]
- Pimentel M, Chang M, Chow EJ, Tabibzadeh S, Kirit-Kiriak V, Targan SR, et al. Identification of a prodromal period in Crohn's disease but not ulcerative colitis. Am J Gastroenterol. 2000;95(12):3458-62. [Crossref] [PubMed]
- Oshitani N, Yukawa T, Yamagami H, Inagawa M, Kamata N, Watanabe K, et al. Evaluation of deep small bowel involvement by double-balloon enteroscopy in Crohn's disease. Am J Gastroenterol. 2006;101(7):1484-9. [Crossref] [PubMed]
- Kopylov U, Yablecovitch D, Lahat A, Neuman S, Levhar N, Greener T, et al. Detection of small bowel mucosal healing and deep remission in patients with known small bowel Crohn's disease using biomarkers, capsule endoscopy, and imaging. Am J Gastroenterol. 2015;110(9):1316-23. [Crossref] [PubMed]
- Yamamoto H, Yano T, Kita H, Sunada K, Ido K, Sugano K. New system of double-balloon enteroscopy for diagnosis and treatment of small intestinal disorders. Gastroenterology. 2003;125(5):1556-7. [Crossref] [PubMed]
- Hülagü S, Şirin G. [Double balloon endoscopy and its role in current gastroenterology practice]. Turkiye Klinikleri J Gastroenterohepatol-Special Topics. 2012;5(1):78-87.
- Pata C, Akyüz Ü, Erzın Y, Mercan A. Double-balloon enteroscopy: the diagnosis and management of small bowel diseases. Turk J Gastroenterol. 2010;21(4):353-9. [Crossref] [PubMed]
- Akarsu M, Akkaya Özdinç S, Celtik A, Akpınar H. Diagnostic and therapeutic efficacy of double-balloon endoscopy in patients with small intestinal diseases: single-center experience in 513 procedures. Turk J Gastroenterol. 2014;25(4):374-80. [Crossref] [PubMed]
- Yamamoto H, Kita H, Sunada K, Hayashi Y, Sato H, Yano T, et al. Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol. 2004;2(11):1010-6. [Crossref]
- Rondonotti E, Spada C, Adler S, May A, Despott EJ, Koulaouzidis A, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy. 2018;50(4):423-46. [Crossref] [PubMed]
- Lee SD, Cohen RD. Endoscopy of the small bowel in inflammatory bowel disease. Gastrointest Endosc Clin N Am. 2002;12(3):485-93. [Crossref]
- Stange EF, Travis SPL, Vermeire S, Beglinger C, Kupcinkas L, Geboes K, et al. European evidence based consensus on the diagnosis and management of Crohn's disease: definitions and diagnosis. Gut. 2006;55(Suppl 1):i1-15. [Crossref] [PubMed] [PMC]
- Lakatos PL, Czegledi Z, Szamosi T, Banai J, David G, Zsigmond F, et al. Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine/biological therapy are predictors of disease behavior change in patients with Crohn's disease. World J Gastroenterol. 2009;15(28):3504-10. [Crossref] [PubMed] [PMC]
- Bourreille A, Ignjatovic A, Aabakken L, Loftus EV Jr, Eliakim R, Pennazio M, et al. Role of small-bowel endoscopy in the management of patients with inflammatory bowel disease: an international OMED-ECCO consensus. Endoscopy. 2009;41(7):618-37. [Crossref] [PubMed]
- Tun GSZ, Rattehalli D, Sanders DS, McAlindon ME, Drew K, Sidhu R. Clinical utility of double-balloon enteroscopy in suspected Crohn's disease: a single-centre experience. Eur J Gastroenterol Hepatol. 2016;28(7):820-5. [Crossref] [PubMed]
- Rahman A, Ross A, Leighton JA, Schembre D, Gerson L, Lo SK, et al. Double-balloon enteroscopy in Crohn's disease: findings and impact on management in a multicenter retrospective study. Gastrointest Endosc. 2015;82(1):102-7. [Crossref] [PubMed]
- Jeong SH, Lee KJ, Kim YB, Kwon HC, Sin SJ, Chung JY. Diagnostic value of terminal ileum intubation during colonoscopy. J Gastroenterol Hepatol. 2008;23(1):51-5. [Crossref] [PubMed]
- Koksal AR, Boga S, Alkim H, Ergun M, Bayram M, Sakiz D, et al. How does a biopsy of endoscopically normal terminal ileum contribute to the diagnosis? Which patients should undergo biopsy? Libyan J Med. 2014;9:23441. [Crossref] [PMC]
- Arulanandan A, Dulai PS, Singh S, Sandborn WJ, Kalmaz D. Systematic review: safety of balloon assisted enteroscopy in Crohn's disease. World J Gastroenterol. 2016;22(40):8999-9011. [Crossref] [PubMed] [PMC]
- Morar PS, Faiz O, Warusavitarne J, Brown S, Cohen R, Hind D, et al. Systematic review with meta-analysis: endoscopic balloon dilatation for Crohn's disease strictures. Aliment Pharmacol Ther. 2015;42(10):1137-48. [Crossref] [PubMed]
- Kondo J, Iijima H, Abe T, Komori M, Hiyama S, Ito T, et al. Roles of double-balloon endoscopy in the diagnosis and treatment of Crohn's disease: a multicenter experience. J Gastroenterol. 2010;45(7):713-20. [Crossref] [PubMed]
- Sabaté JM, Villarejo J, Bouhnik Y, Allez M, Gornet JM, Vahedi K, et al. Hydrostatic balloon dilatation of Crohn's strictures. Aliment Pharmacol Ther. 2003;18(4):409-13. [Crossref] [PubMed]
- Pennazio M, Spada C, Eliakim R, Keuchel M, May A, Mulder CJ, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of smallbowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2015;47(4):352-76. [Crossref] [PubMed]
.: İşlem Listesi