**Table 3.**

**59**

*Role of Small Bowel Endoscopy in Diagnosis and Management of Inflammatory Bowel Disease…*

(36.4%). The diagnostic yield is higher if DAE is preceded by prior small bowel evaluation to decide the insertion route. The diagnostic yield drops drastically if DAE is performed for non-specific abdominal symptoms. DAE can significantly

DAE can be performed with therapeutic intent in established CD to dilate short (<5 cm), non-inflammatory strictures (4E-F), insert stents, inject intra-lesional steroid, remove foreign body like capsule or Bezoar and rarely to treat major haemorrhage in CD. Reported technical success for stricture dilatation ranges from

Strictures in Crohn's disease (CD) are secondary to inflammation, fibrosis, or both. The risk of fibrotic stricture increases with the disease duration; such strictures are seen in 30% to 35% of patients within 10 years of diagnosis of CD [36]. Despite biologic use, the incidence of strictures remains unchanged in CD [70]. Endoscopic stricturotomy and balloon dilatation are the most common endoscopic procedures performed for CD strictures. However, both are associated with a high

The use of self-expanding metal stents (SEMS) have been reported for CD strictures with high technical success rate. However, it is associated with risk of perforation, stent migration, and fistula [71, 72]. Premature stent failure is the drawback of biodegradable stents, used to circumvent adverse events of SEMS. Currently available biodegradable stents are not specifically designed for CD strictures [73–75]. In a recent single-center series of CD patients, removable SEMS therapy for short (6 cm) fibrostenotic strictures of terminal ileum/ ileocolonic anastomoses was technically successful in 95.8%. The stents were removed within 7 days. On long-term follow-up (3–50 months), none of the patients required stricture-related surgery [76]. The global interventional inflammatory bowel disease (IBD) group recommendations has positioned fully covered SEMS for refractory strictures in selected patients failing balloon dilatation and endoscopic stricturotomy [77].

The technical success rate (defined as successful dilatation leading to endoscope passage) of endoscopic balloon dilatation (EBD) for CD strictures varies from 72% to 100% (**Table 4**). The clinical success, defined as in improvement in patient's

The dilatation diameter varied from 12.4 to 17 mm with maximum of 20 mm. The recurrence rate varied from 14% to 78.5% based on duration of follow up. In studies with more than 3 years of follow up, the recurrence rates were 48% and 78.5%, respectively. Overall, most recurrences can be successfully treated with repeat balloon dilatation with a cumulative surgery free rate of 78% at 3 years. So, long term high recurrence rates and need for repeated dilatation or surgery should

DAE is safe and effective for children aged >3 years and weight > 14 kg. DAE is challenging in children due to small abdominal cavity, thinner small bowel wall and a narrow lumen requiring considerable expertise. Five studies (2 SBE, 2 DBE and 1 BGE) have evaluated the role of DAE in paediatric IBD. In these studies, DAE either led to treatment escalation or was used to perform stricture dilatation. Definitive IBD type was ascertained in patients with IBD-U after BGE in a feasibility and safety study. These studies did not report any major complications with diagnostic or therapeutic DAE. DAE related complications in paediatric patients are reported

60–80% and perforation rates as high as 9% has been described [69].

*DOI: http://dx.doi.org/10.5772/intechopen.96006*

*5.4.2 Therapeutic DAE*

impact patient management in 17% to 82% [60–68].

risk of recurrence, re-intervention and surgery.

obstructive symptoms, is around 60%.

*5.4.3 DAE in paediatric patients*

be kept in mind prior to EBD for CD strictures [69, 78–82].

*Summary of studies on diagnostic yield of device assisted enteroscopy (DAE) in Crohn's disease (CD); SBE- single balloon enteroscopy, DBE- double balloon enteroscopy, BGE- balloon guided enteroscopy [69–78, 81–86]* (36.4%). The diagnostic yield is higher if DAE is preceded by prior small bowel evaluation to decide the insertion route. The diagnostic yield drops drastically if DAE is performed for non-specific abdominal symptoms. DAE can significantly impact patient management in 17% to 82% [60–68].
