title: Current status of double balloon endoscopy--indications, insertion route, sedation, complications, technical matters.
abstract: BACKGROUND
  The recent development of double balloon endoscopy (DBE) has revolutionized enteroscopy. This system allows for endoscopic scrutiny and treatment of the entire small bowel, but general consensus has not yet been reached regarding procedural guidelines.
  
  
  METHODS
  We have been using the DBE system since June 2003, at Nippon Medical School Hospital, Tokyo, Japan, where 163 patients have undergone 265 DBE examinations. This study presents a detailed analysis of the current status of DBE examination at our institution, with particular focus on indications, contraindications, sedation, choice of insertion route, complications, and relevant technical points.
  
  
  METHODS
  The most common indication for DBE was obscure GI bleeding. Patients were placed under conscious or deep sedation and their vital signs were monitored throughout the examination. The choice of either an oral or anal insertion route was determined on the basis of clinical symptoms or any previous examination data. When analyzing the entire small bowel, we began via the anal route and marked the intestine with India ink at the furthest insertion point lying closest to the oral route. We then switched our approach to the oral route, and confirmed total enteroscopy when the enteroscope reached the India-ink mark. With regard to complications, we encountered 1 case of acute pancreatitis and 2 cases of aspiration pneumonia after examination.
  
  
  CONCLUSIONS
  The DBE system allows for full investigation of the pathology of the small intestine and timely endoscopic treatment. However, for the DBE system to achieve more widespread acceptance, it is critical that we establish a universal method for its safe and efficient use.
authors: Department of Internal Medicine, Division of Gastroenterology, Nippon Medical School, Tokyo, Japan.
authors: Shu
authors: S
authors: Tanaka
authors: Keigo
authors: K
authors: Mitsui
authors: Atsushi
authors: A
authors: Tatsuguchi
authors: Tsuyoshi
authors: T
authors: Kobayashi
authors: Akihito
authors: A
authors: Ehara
authors: Katya
authors: K
authors: Gudis
authors: Choitsu
authors: C
authors: Sakamoto
mesh_terms: D016292:Procedural Sedation; D000075202:Contraindications; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D004867:Equipment Design; D005471:Fluoroscopy; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000628:therapy; D007421:Intestine, Small