BACKGROUND Owing to the development of double-balloon enteroscopy (DBE) and video capsule endoscopy (VCE) in recent years, direct visualization of the entire small intestinal mucosa has become possible. Because of the nonspecific symptoms and the anatomic location of the small bowel, diagnosis of isolated small bowel Crohn's disease (CD) remains a challenge. The aim of this research was to explore the value of DBE for isolated small bowel CD in situations where routine tests cannot confirm the diagnosis. METHODS This study included patients with suspected isolated small bowel CD who were hospitalized in Shengjing Hospital from April 2014 to June 2018. We included patients presenting with chronic diarrhea, abdominal pain, abdominal mass, perianal lesions, and systemic symptoms including weight loss, fever, and anemia after excluding infection factors. Patients with purely colonic CD were excluded from this cohort. Patients with suspected isolated small bowel CD underwent DBE. RESULTS In 16/18 patients, pathological findings were detected by DBE. In 12 of the cases, small bowel CD was confirmed. The remaining four patients were diagnosed with small bowel inflammation, duodenal carcinoma, ileum inflammation and small bowel ulcers. However, the diagnosis of CD was confirmed in 14/18 (78%) patients by taking into account the clinical presentation, endoscopic and histological results as well as the experimental treatment. DBE assisted in the diagnosis in 86% (12/14) of the patients. CONCLUSIONS In the diagnosis of small bowel CD, DBE is a helpful tool. Before assessment with DBE, clinical features, colonoscopy, and CT were used to initially assess the intestine. According to the lesions indicated by CT, we chose the most appropriate endoscope insertion route, and combined the endoscopic characteristics and pathological results of DBE to confirm the diagnosis.

中文翻译：

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双气囊肠镜对疑似孤立性小肠克罗恩病患者的诊断效力。

背景技术由于近年来双气囊肠镜（DBE）和视频胶囊内窥镜（VCE）的发展，整个小肠粘膜的直接可视化已经成为可能。由于小肠的非特异性症状和解剖位置，孤立小肠克罗恩病（CD）的诊断仍然是一个挑战。这项研究的目的是探讨在常规检查不能确定诊断的情况下，DBE对于孤立的小肠CD的价值。方法该研究包括2014年4月至2018年6月在圣京医院住院的疑似孤立小肠CD患者。我们纳入了具有慢性腹泻，腹痛，腹部肿块，肛周病变以及全身症状（包括体重减轻，发烧，排除感染因素后出现贫血。纯结肠CD患者被排除在这一队列之外。怀疑患有孤立性小肠CD的患者接受DBE。结果在16/18例患者中，DBE检测到了病理结果。在12例病例中，证实了小肠CD。其余四名患者被诊断出患有小肠炎症，十二指肠癌，回肠炎症和小肠溃疡。但是，考虑到临床表现，内窥镜检查和组织学结果以及实验治疗，在14/18（78％）患者中确诊了CD。DBE帮助86％（12/14）的患者进行诊断。结论DBE是诊断小肠CD的有用工具。在评估DBE，临床特征，结肠镜检查，和CT最初用于评估肠道。根据CT显示的病变情况，选择最合适的内窥镜插入途径，结合内镜特点和DBE的病理结果，明确诊断。