Roles of double-balloon endoscopy in the diagnosis and treatment of Crohn's disease: a multicenter experience.

BACKGROUND: Double-balloon endoscopy (DBE) examinations are not yet widely accepted as routine procedures for examining the small bowel of patients with Crohn's disease (CD). AIM: To evaluate the feasibility and usefulness of DBE for CD in tertiary-care hospitals. METHODS: Between July 2004 and September 2008, 1444 DBE procedures were performed for 704 patients in 6 tertiary-care hospitals. Patient profile, indication, diagnosis and treatment of DBE were evaluated using a multicenter database. RESULTS: DBE examinations were most frequently performed in 75 patients with CD, corresponding to 10.5% of all the patients examined by DBE. Fifty patients were diagnosed with CD before DBE, while DBE was performed for the diagnosis of 25 new CD patients. Small bowel lesions were often detected even when the terminal ileum was not involved. In the 75 patients, 21 patients were asymptomatic at the time of DBE examinations. Active inflammatory lesions were detected in 51.2% of the CD patients, and were even detected in 33.3% of the asymptomatic CD patients. The treatment was altered in 53.3% of the CD patients after the DBE evaluation. No severe complications were experienced. CONCLUSIONS: DBE procedures can be safely performed in patients with CD and should be considered for the precise evaluation of and to determine the treatment strategy for CD.

Massive vascular leiomyoma of the hand.

A patient presented with a massive (5.0 x 4.0 x 3.0 cm) vascular leiomyoma (angioleiomyoma) in the hand, which had developed over a 50-year-period without pain. The clinical presentation, microscopic findings, and behaviour of vascular leiomyoma are described.