Role of small bowel endoscopy in children with known inflammatory bowel disease

Posted by Doctor Mai Vien Phuong - Department of Examination & Internal Medicine - Vinmec Central Park International Hospital

Five studies, two studies on single-balloon colososcopy, two studies on dual-balloon enteroscopy, and one study on guided-balloon endoscopy evaluated the impact of an assistive endoscopic system. balloon support in children with established IBD.

Five studies, two studies on single-balloon colososcopy, two studies on dual-balloon enteroscopy, and one study on guided-balloon endoscopy evaluated the impact of an assisted endoscopic system. balloon support in children with established IBD.
In a study by several authors, the findings of single-balloon colostrum endoscopy in 14 patients with long-standing Crohn's disease and symptoms not explained by conventional colonoscopy led to the referral or replacement of modified treatment in 11 patients. Furthermore, single-balloon enteroscopy allowed successful and safe dilation of strictures identified on abdominal MRI in 3 patients.
In the study by de Ridder et al., the findings of single-balloon enteroscopy led to a change in therapy in 5 out of 6 patients with Crohn's disease.
In the paper by Urs et al., in the established Crohn's disease group, 2 patients had an adverse reaction to infliximab with poor response to adalimumab and 3 patients underwent dual-balloon enteroscopy for evaluation. disease and consider escalating treatment. Dual-balloon enteroscopy resulted in a change of treatment in all 5 patients.

Uchida et al evaluated the efficacy and safety of dual-balloon enteroscopy in 4 children with established Crohn's disease. Following dual-balloon enteroscopy, one patient underwent balloon angioplasty and altered medical therapy, and in two patients surgical resection was planned. In one patient, a dual-balloon enteroscopy was performed to evaluate for intestinal lesions due to persistent abdominal pain, and only small erosions were found near the ileal foramen; therefore, therapy after endoscopic double-balloon enteroscopy was not altered.

The most common complications associated with device-assisted small bowel endoscopy are perforation, bleeding, and pancreatitis, with an overall patient prevalence of about 1%.
A large retrospective Japanese study identified 29068 patients who underwent a diagnosis of a balloon-assisted colonoscopy system, reporting 32 cases of perforation (0.11%). Nine hundred and forty-two patients underwent a subsequent balloon-assisted endoscopic system treatment, but no perforation occurred in this group.

Univariate logistic regression analysis showed that patients with IBD, regardless of steroid treatment, had a significantly higher risk of perforation than patients without (8.6-fold and 2.5-fold, respectively). In most published studies, perforation rates in Crohn's disease patients undergoing endoscopic balloon dilation varied from 0% to 10% of subjects, although a small group reported a perforation rate of 20%. . Bleeding after balloon dilation of Crohn's disease occurs in about 2.5% of patients, and it usually requires only conservative management. Finally, pancreatitis was reported to occur in 0.3% of patients, especially after procedures with a retrograde approach. Adverse event rates for different types of assistive small bowel endoscopy have been shown to be similar.
In the pediatric literature, major complications are reported only for therapeutic procedures. A large retrospective study of 257 pediatric double-balloon endoscopic procedures reported an overall complication rate of 5.4% (10.4% in patients younger than 10 years). No major complications related to diagnostic or therapeutic procedures have been reported in the pediatric IBD setting.
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