| Objective:Small bowel diseases are one of the most puzzling digestive diseases. Small bowel diseases can seriously stunt the growth and development of teenagers. Therefore, early diagnosis of small bowel disease is of great importance for the treatment of the diseases. Human small intestine is about 5-7 meters in length, tortuous and far away from both ends of the digestive tract, which makes it difficult for conventional endoscopy to achieve the lesions in the small bowel. Whereas, double-balloon enteroscopy assisted with two balloons can achieve a great insertion depth, complete pan-intestine examination, rendering it useful for the diagnosis of small bowel disorders. This paper aims to get a preliminary understanding of the clinical manifestations of small bowel diseases in children and youths and their potentional common causes, and also to explore the value of double-balloon enteroscopy in detecting small bowel diseases, by analyzing the case files of teenagers who were suspected with small bowel disease and underwent a double-balloon enteroscopy and combining with the clinical diagnosis of patients discharged from hospital and follow-up results.Methods:All patients suspected with small bowel disorders who visited the endoscopic center and underwent double-balloon enteroscopy in Renmin Hospital of Wuhan University from September 2007 to March 2015 were collected. In total,59 patients younger than 28-year-old were included. According to age,59 included patients were divided into the Children Group and the Youth Group. The clinical symptoms, the potential causes of the two groups and the results of double-balloon enteroscopy were analyzed and compared.Results:1.Groups:All the included patients suspectedd with small bowel disorders who visited the endoscopic center and underwent double-balloon enteroscopy in Renmin Hospital of Wuhan University from September 2007 to March 2015 were divided into the Children Group and the Youth Group:There were a total of 18 cases in the Children Group, including 16 males and 2 females, aged 12-17 years, the mean ages were 15.6±1.4 years; There were a total of 41 cases in the Youth Group, including 36 males and 5 females, aged 18-28 years, mean ages were 23.5±3.0 years; There was no significant difference between the two groups (x2=0.014, P=0.905) in the gender distribution.2. Clinical manifestations:Overall, the patients with small bowel disorders complained mostly of hematochezia (33.9%), melena (27.1%), abdominal pain (20.3%); whereas the Children Group complained mostly of melena (27.8%), hematochezia (22.2%), abdominal pain (22.2%); the Youth Group complained mostly of hematochezia (39.0%), melena (26.8%), abdominal pain (19.5%); There was no significant difference (x2=2.536, P=0.864) between the two groups in the symptoms distribution.3. Obscure gastrointestinal bleeding:There was a total of 42 patients who complained of obscure gastrointestinal bleeding,29 cases (69.0%) presented with acute hemorrhage, of which 13 cases (44.8%) with acute hemorrhage had a previous history of bleeding, the other 13 cases (30.9%) presented with chronic bleeding, in which the most common causes were intestinal diverticulum in 9 cases (32.0%), Crohn’s disease in 5 cases (38.5%), respectively; 12 patients in the Children Group complained of gastrointestinal bleeding, in which 8 cases presented with acute hemorrhage and 4 cases presented with chronic bleeding. The most common causes were intestinal diverticulum in 5 cases (62.5%), Crohn’s disease in 2 cases (50%), respectively; 30 cases of the young patients complained of gastrointestinal bleeding, including 21 cases presenting with acute hemorrhage and 9 cases presented with chronic bleeding. The most common causes were enteric duplication in 5 cases (23.8%), Crohn’s disease in 3 cases (33.3%), respectively; There was no significant difference (x2=0.045, P=0.833) between the two groups in the course distribution.4. Abdominal pain:A total of 18 patients complained of abdominal pain,11 presented with chronic abdominal pain. Overall, the most common cause of abdominal pain was Crohn’s disease in 9 cases (50%); 7 patients were children who complained of abdominal pain, and 4 cases were children with chronic abdominal pain. The most common cause of abdominal pain in children was Crohn’s disease in 4 cases (57.1%); 11 young patients were with abdominal pain, and 7 patients presented with chronic abdominal pain. The most common cause of abdominal pain in young patients was Crohn’s disease in 5 cases (45.5%). There was no significant difference (x2=0.076, P=0.783) between two groups inn the course distribution..5. Double-balloon enteroscopy:In all the cases, there were a total of 12 patients who completed a whole small intestine examination, with a completion rate of 20.3%, including 2 children and 10 youths. The completion rate of the whole small intestine in children and youths was 11.1% and 24.4%, respectively. There was no significant difference (P=0.415) between the two groups in the completion rate. The detection rate of double-balloon enteroscopy was 78.0% for gastrointestinal lesions and 74.6% for small bowel lesions.In the Children Group, the total lesion detection rate was 83.3%, while in the Youth Group, the total lesion detection rate was 75.6%. In patients with obscure gastrointestinal bleeding in the Children Group, the lesion detection rate was 91.7%, while in the youth group, the rate was 70.0%. The lesion detection rate in children with abdominal pain was 71.4%, while in youth, the rate was 81.8%; There was no significant difference (P=0.276-1.000) in lesion detection rate between the two groups. There was no significance (P=0.725) between the Children and the Youth groups in the distribution of types of lesions. The most common lesion detected in the small intestine was inflammatory changes (45.5%), followed by intestinal malformations (38.6%), vascular disease (6.8%), polyps (4.5%), cancer (2.3%) and others (2.3%). There was no significance (P=0.250)between the Children and the Youth Groups in the location distribution of the lesions detected, ileum being the most commonly involved, followed by the jejunum and the duodenum.6. Comparison with other examinations:When compared with other examinations, there was a poor diagnostic consistency between double-balloon enteroscopy and CT/CTE (7 cases), a moderate diagnostic consistency between double-balloon eneteroscoy and capsule endoscopy (n=4), a high diagnosis consistency between double-balloon eneteroscoy and DSA (2 cases), with the Kappa values being 0,0.5,1.0, respectively.7. Safety:Double-balloon enteroscopy was a safe way to diagnose small intestinal diseases. Apart from a transient hyperamylasemia, there were no serious complications in the two groups, and the complication rate was 5.6%,9.8%, respectively, and a pooled complication rate of 8.5%.Conclusion:Small intestinal diseases occured mainly in men, and the clinical manifestations in children and young people are not specific, mostly presented with gastrointestinal bleeding and abdominal pain. Most teenagers with small intestinal malformations and Crohn’s disease presented with gastrointestinal bleeding as the first symptom, while patients with Crohn’s disease might be accompanied with other symptoms such as chronic abdominal pain. Inflammatory changes and small intestinal malformation most commonly occurred in teenagers, with ileum being the most likely site involved. Double balloon enteroscopy boast a higher diagnostic yield and safety for detecting small intestinal diseases in teenagers, which makes it an effective means in the diagnosis of small intestinal disease. |
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