Diagnostic and Clinical Impact of Double-Balloon Enteroscopy in Small-Bowel Inflammatory Lesions: A Retrospective Cohort Study in a Turkish Population

Background: /Aims: Small bowel inflammatory lesions are challenging to diagnose owing to the anatomical complexity and limitations of conventional imaging. Double-balloon enteroscopy (DBE) allows for direct visualization, biopsy, and therapeutic intervention. This study evaluated the diagnostic yield and clinical impact of DBE in small-bowel inflammatory lesions, particularly in differentiating Crohn’s disease (CD) from other etiologies. Methods: This retrospective study included 258 patients who underwent DBE for suspected small-bowel inflammatory lesions at Dokuz Eylül University Hospital (2010–2024). Patients were categorized into the CD and non-CD groups. Clinical, radiological, and endoscopic findings were also analyzed. Statistical comparisons were performed to assess the differences in presentation and DBE findings between the groups. Results: The mean patient age was 48.2±17.3 years. Abdominal pain (47.7%) and diarrhea (31.8%) were the most common symptoms. DBE findings included ulcers (45.0%), superficial mucosal changes (23.3%), and strictures (9.7%). The ileum was the most commonly affected site (31.7 %). CD was diagnosed in 27.5% of the patients, while other etiologies included Non-Steroidal Anti-Inflammatory Drug (NSAID) enteropathy (12.0%) and malignancies (15.9%). Ulcers were significantly more frequent in patients with CD than in those without (60.3% vs. 39.0%, p=0.002). Conclusion: DBE plays a crucial role in diagnosing small-bowel inflammatory lesions, distinguishing CD from other conditions, and guiding clinical management. It remains essential for cases requiring histopathological confirmation, offering superior diagnostic accuracy compared to noninvasive imaging.