title: The European experience with double-balloon enteroscopy: indications, methodology, safety, and clinical impact.
abstract: BACKGROUND
  Double-balloon enteroscopy (DBE) is a new technique that allows high-resolution visualization, biopsies, and therapeutic interventions in all segments of the GI tract. The objective of the study was to evaluate the indications, the safety, and the clinical impact of DBE.
  
  
  METHODS
  This is a retrospective analysis conducted at 4 European medical centers. A total of 62 patients with suspected or documented small-bowel diseases were investigated by DBE. A total of 89 procedures were performed (26 and 9 patients from the oral or the anal route, respectively; 27 patients from both). The main outcome measurements were complications, depth and time of insertion, diagnostics, and therapeutics rates.
  
  
  RESULTS
  No complications occurred. Mean time was 70 +/- 30 minutes and 90 +/- 35 minutes from the oral and the anal route, respectively. Length of insertion was 254 +/- 174 cm beyond the pylorus, 180 +/- 150 cm beyond the ileocecal valve, whereas the entire small bowel was completely explored in 10 patients. DBE was diagnostic in 80% of the patients: in 29 of 33 of patients with GI bleeding, in one of 5 patients with iron deficiency anemia and positive fecal occult blood testing, in 3 of 5 patients with chronic diarrhea, in two of 3 patients with abdominal pain, in two of 3 patients with GI cancer (follow-up), in all patients with suspected or refractory celiac disease, and in two of 3 patients with Crohn's disease. Treatment was performed in 41.9% of patients (22 polyps and 29 angioectesias).
  
  
  CONCLUSIONS
  DBE is a safe and feasible diagnostic and therapeutic tool for suspected or documented small-bowel diseases. At present, the best candidates for the procedure appear to be those with obscure GI bleeding.
authors.affiliation: Internal Medicine and Endoscopic Surgery, Gemelli Hospital, Catholic University of Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Di Caro
authors.forename: Andrea
authors.initials: A
authors.lastname: May
authors.forename: Dimitri G N
authors.initials: DG
authors.lastname: Heine
authors.forename: Lucia
authors.initials: L
authors.lastname: Fini
authors.forename: Bruno
authors.initials: B
authors.lastname: Landi
authors.forename: Lucio
authors.initials: L
authors.lastname: Petruzziello
authors.forename: Christophe
authors.initials: C
authors.lastname: Cellier
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Mulder
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
authors.forename: Christian
authors.initials: C
authors.lastname: Ell
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
mesh_terms: D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004867:Equipment Design; D004869:Equipment Safety; D005060:Europe; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies