Baseline Double-Balloon Enteroscopy Findings and Long-Term Outcomes in Pediatric Crohn's Disease

Background  Pediatric Crohn's disease is frequently characterized by extensive small-bowel involvement and a dynamic disease course. Double-balloon enteroscopy (DBE) allows direct evaluation of proximal small-bowel lesions that may not be detected by conventional upper gastrointestinal endoscopy and ileocolonoscopy; however, the long-term clinical implications of baseline DBE findings remain poorly defined. Methods We conducted a retrospective, single-center longitudinal cohort study including pediatric patients initially diagnosed with Crohn's disease who underwent baseline DBE. Clinical and endoscopic disease activity were assessed using the Harvey-Bradshaw Index (HBI) and the Simple Endoscopic Score for Crohn's Disease (SES-CD), respectively, at baseline and after approximately 10 years of follow-up. Patients with diagnostic reclassification during follow-up were excluded from remission analyses but analyzed descriptively. Results  Twenty patients underwent baseline DBE; three (15%) were subsequently reclassified to alternative diagnoses. Among the remaining 17 (85%) patients with a final diagnosis of Crohn's disease, both clinical and endoscopic disease activity substantially improved over long-term follow-up. Baseline DBE identified ulcerative jejunal disease in a subset of patients. At follow-up, patients with ulcerative lesions identified on baseline DBE tended to exhibit lower rates of clinical and endoscopic remission compared with those without proximal ulceration. These subgroup findings were exploratory in nature. Conclusions  In pediatric patients initially diagnosed with Crohn's disease, baseline DBE findings were associated with distinct long-term clinical and endoscopic trajectories. Additionally, the observed rate of diagnostic reclassification underscores the importance of longitudinal reassessment in this population. DBE may provide complementary phenotypic information beyond standard endoscopic evaluation in selected pediatric patients.