title: Double-balloon enteroscopy in Ireland in the capsule endoscopy era.
abstract: BACKGROUND
  The availability of double-balloon enteroscopy (DBE) and small bowel capsule endoscopy (SBCE) in Ireland has revolutionised our approach to the diagnosis and treatment of small bowel disorders.
  
  
  OBJECTIVE
  To evaluate the use of DBE in Ireland and to compare the diagnostic yield with and without prior SBCE in order to improve the efficiency of our resources for small bowel endoscopy.
  
  
  METHODS
  A retrospective comparison study of all DBEs performed between two centres, one with SBCE available, was undertaken. Information was obtained by review of endoscopy reports, referral letters, radiology reports and charts. A review of the SBCE database was undertaken to identify patients who had undergone SBCE prior to DBE.
  
  
  RESULTS
  A total of 242 DBE procedures were carried out between both centres. SBCE was performed prior to DBE in 20 % (n = 46). The overall diagnostic yield of DBE was 47 % (n = 115). There was a statistically significant difference in diagnostic yield between the DBE only and the DBE with prior SBCE groups 44 versus 61 %, respectively, p < 0.0001. There was also a significant difference in the DBE approach, with 73 % of procedures being anterograde in centre 1 versus 56 % in centre 2. A subgroup analysis of centre 1 data revealed a negative predictive value of 100 % and a positive predictive value of 74 % for SBCE when DBE findings were considered as a gold standard.
  
  
  CONCLUSIONS
  SBCE as a screening tool prior to DBE is extremely valuable and increases the diagnostic yield considerably as a consequence of a high negative predictive value.
authors.affiliation: Department of Gastroenterology, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland, grainneholleran@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Holleran
authors.forename: B
authors.initials: B
authors.lastname: Hall
authors.forename: M
authors.initials: M
authors.lastname: Alhinai
authors.forename: A
authors.initials: A
authors.lastname: Zaheer
authors.forename: R
authors.initials: R
authors.lastname: Leen
authors.forename: A
authors.initials: A
authors.lastname: Alakkari
authors.forename: N
authors.initials: N
authors.lastname: Mahmud
authors.forename: D
authors.initials: D
authors.lastname: McNamara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053704:Capsule Endoscopy / Q000379:methods*; D058582:Double-Balloon Enteroscopy / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000175:diagnosis*; D007421:Intestine, Small / Q000473:pathology*; D007494:Ireland; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult