Efficacy of double-balloon enteroscopy in the evaluation and treatment of bleeding and non-bleeding small bowel disease

Double-balloon enteroscopy (DBE) is a newly developed method allowing deep insertion of a thin endoscope into the small bowel, thereby enabling inspection, biopsy and endoscopic treatment of previously inaccessible lesions. This retrospective analysis evaluates the diagnostic and therapeutic efficacy in all patients undergoing DBE at our institution. A total of 109 DBEs were performed in 82 patients (57 patients with suspected small bowel blood loss and 25 patients with other indications). The diagnostic success rate was 51 of 82 (62%) with a higher rate in bleeders in whom angiodysplasias were the most frequent diagnosis. DBE had therapeutic consequences in 47 patients (57%), of whom 33 patients (40%) underwent endoscopic therapy and 6 patients (7%) surgery. In 4 patients, malignant neoplasias were newly diagnosed (2 gastrointestinal stroma tumors, I neuroendocrine tumor, I adenocarcinoma). Other diagnostic modalities were helpful in preselecting patients for DBE and choosing the more favorable (oral or anal) access. In 16 of 26 patients, pathological findings in videocapsule endoscopy were substantiated by DBE. In 7 patients, the findings of CT or MRI enteroclysis, and in 4 patients with hematochezia, the results of a preceding erythrocyte bleeding scan were confirmed by DBE. In conclusion, this series indicates that DBE of the small bowel - in concert with other diagnostic modalities - has a high diagnostic and therapeutic efficacy.