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.