title: Small bowel endoscopy using the double-balloon technique: four-year results in a tertiary referral hospital in Brazil.
abstract: BACKGROUND
  Double-balloon enteroscopy (DBE) allows evaluation and therapy for various small bowel diseases. In this series the outcome of a 4-year experience in a tertiary hospital school in Brazil is reported.
  
  
  METHODS
  A total of 457 consecutive DBE were performed in 418 patients from August 2004 to August 2008. 93 patients with several indications, whose aim was not the evaluation of suspected diseases of the small bowel mucosa, were excluded, therefore leaving 364 DBE in 325 patients for analysis. Data were retrospectively collected with regard to clinical, endoscopic findings, therapy and complications.
  
  
  RESULTS
  Among the 364 DBE performed in 325 patients, 143/325 were males (44%) and 182/325 females (56%) with a mean age of 48.6 +/- 15.7 years (range 17-89). Mean investigation time was 64 +/- 22 min (range 35-135). The depth of insertion beyond the ligament of Treitz was 230 +/- 85 cm (range 30-500) by the antegrade approach and 140 +/- 75 cm (range 0-320) by the retrograde approach. Total enteroscopy was achieved in 41.66% of the attempts (30 of 72 patients). Overall diagnostic yield was 54.95% (200 of 364 procedures) ranging from 0 to 100% in this series, depending on the indication. Angiodysplasia was the main diagnosis in 24.5% (49 of 200 procedures) and endoscopic treatment, including biopsies, hemostasis, tattooing and polypectomy were performed in 65.38% (238 of 364 procedures). No major complications were reported.
  
  
  CONCLUSIONS
  DBE is a feasible, safe and well-tolerated procedure allowing endoscopic therapy. Selection of indications increases its diagnostic yield.
authors.affiliation: Gastrointestinal Endoscopy Unit, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil. rogeriokuga@yahoo.com.br
authors.forename: Rogerio
authors.initials: R
authors.lastname: Kuga
authors.forename: Adriana Vaz
authors.initials: AV
authors.lastname: Safatle-Ribeiro
authors.forename: Robson Kiyoshi
authors.initials: RK
authors.lastname: Ishida
authors.forename: Felipe
authors.initials: F
authors.lastname: Retes
authors.forename: Ricardo Sato
authors.initials: RS
authors.lastname: Uemura
authors.forename: Paulo
authors.initials: P
authors.lastname: Sakai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016888:Angiodysplasia / Q000150:complications; D001938:Brazil; D002404:Catheterization / Q000379:methods*; D004724:Endoscopy; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006761:Hospitals; D006801:Humans; D007421:Intestine, Small / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation