title: Performance of antegrade double-balloon enteroscopy: comparison with push enteroscopy.
abstract: BACKGROUND
  Double-balloon enteroscopy (DBE) is a novel procedure for the diagnosis of small-bowel pathology. The aim of this retrospective study was to compare the performance and the diagnostic value of antegrade DBE with those of push enteroscopy (PE).
  
  
  METHODS
  We reviewed endoscopic and histologic findings in 118 patients examined by PE or antegrade DBE during a period 1980 to 2004. The maximal length of insertion under plain radiograph was compared between patients examined by PE and those examined by antegrade DBE. Diagnostic yield was compared among patients stratified by indication for enteroscopy and the duodenal pathology.
  
  
  RESULTS
  Ninety-one patients were examined by PE and 27 patients by antegrade DBE. Length of insertion from the ligament of Treitz was significantly greater in antegrade DBE (median, 92 cm; range, 40-144 cm) than in PE (median, 22 cm; range, 0-98 cm; p < 0.0001). In 90 nonbleeding patients with inflammatory or miscellaneous diseases or polyposis, the diagnostic yield was not different between PE and antegrade DBE (64% vs. 82%, p = 0.13). However, it was higher in antegrade DBE (79%) than in PE (31%, p = 0.012) in nonbleeding patients without duodenal pathology. In bleeding patients, the diagnostic yield was 40% in antegrade DBE and 36% in PE (p = 0.61).
  
  
  CONCLUSIONS
  Antegrade DBE is superior to PE in exploration of the small intestine and in diagnostic yield for small-intestinal pathology.
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Moriyama
authors.forename: Motohiro
authors.initials: M
authors.lastname: Esaki
authors.forename: Shotaro
authors.initials: S
authors.lastname: Nakamura
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Iida
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000473:pathology / Q000601:surgery; D007414:Intestinal Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D007421:Intestine, Small / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric