title: What is the learning curve associated with double-balloon enteroscopy? Technical details and early experience in 6 U.S. tertiary care centers.
abstract: BACKGROUND
  Performance parameters for double-balloon enteroscopy (DBE) have not been described.
  
  
  OBJECTIVE
  To determine the learning curve for DBE.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Six U.S. tertiary centers.
  
  
  METHODS
  A total of 188 subjects undergoing 237 DBE procedures; 130 (69%) with obscure GI bleeding.
  
  
  METHODS
  Performance parameters from each center's initial 10 cases were compared to the subsequent examinations.
  
  
  METHODS
  Exam duration, depth of insertion, and findings on DBE examination.
  
  
  RESULTS
  DBE was introduced by mouth in 149 (63%) cases, by rectum in 77 (33%) cases, and through a stoma in 6 (2.5%) patients. The mean (+/-SD) duration was 109.1 +/- 44.6 minutes for the first 10 cases and 92.4 +/- 37.6 minutes for subsequent cases (P = .005) but did not change for rectal DBE procedures. There was no change in mean depth of insertion, but the mean fluoroscopy time declined significantly (P = .025). Diagnostic or therapeutic maneuvers were performed in 64% of cases; DBE led to a diagnosis in 81 (43%) patients. A total of 78% of patients had prior capsule endoscopy (CE) with significant agreement between DBE and CE (kappa = 0.74). One perforation occurred (0.4%). Per-rectal cases failed to reach the small bowel in 24 (31%) cases.
  
  
  CONCLUSIONS
  All patients did not undergo initial CE. The therapeutic DBE scope was not available for the initial 8 months of the study.
  
  
  CONCLUSIONS
  There was a significant decline in overall procedural time and fluoroscopy time after the initial 10 DBE cases. There was no improvement in performance parameters when DBE was performed via the rectal approach despite increased, but limited, operator experience.
authors.affiliation: Department of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
authors.forename: Shahab
authors.initials: S
authors.lastname: Mehdizadeh
authors.forename: Andrew
authors.initials: A
authors.lastname: Ross
authors.forename: Lauren
authors.initials: L
authors.lastname: Gerson
authors.forename: Jonathan
authors.initials: J
authors.lastname: Leighton
authors.forename: Ann
authors.initials: A
authors.lastname: Chen
authors.forename: Drew
authors.initials: D
authors.lastname: Schembre
authors.forename: Gary
authors.initials: G
authors.lastname: Chen
authors.forename: Carol
authors.initials: C
authors.lastname: Semrad
authors.forename: Ahmad
authors.initials: A
authors.lastname: Kamal
authors.forename: Edwyn M
authors.initials: EM
authors.lastname: Harrison
authors.forename: Kenneth
authors.initials: K
authors.lastname: Binmoeller
authors.forename: Irving
authors.initials: I
authors.lastname: Waxman
authors.forename: Richard
authors.initials: R
authors.lastname: Kozarek
authors.forename: Simon K
authors.initials: SK
authors.lastname: Lo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D004724:Endoscopy / Q000193:education*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D005260:Female; D005471:Fluoroscopy; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012107:Research Design; D014481:United States