Double-balloon endoscopy in clinical practice: where are we now?

Area of Science:

• Gastroenterology
• Endoscopy
• Small Bowel Diseases

Background:

• Double-balloon endoscopy (DBE) emerged in 2000, significantly impacting small bowel disease diagnosis and treatment.
• DBE, alongside capsule endoscopy (CE), offers revolutionary therapeutic options for the small intestine.

Purpose of the Study:

• To review the diagnostic and therapeutic applications of DBE in managing small bowel pathologies.
• To assess the efficacy and safety of DBE for key indications like obscure GI bleeding, Crohn's disease, and familial polyposis.

Main Methods:

• Review of clinical practice and published studies on double-balloon endoscopy.
• Analysis of DBE's performance compared to capsule endoscopy for obscure GI bleeding.
• Evaluation of therapeutic interventions, including stricture dilation and polyposis management.

Main Results:

• DBE demonstrates comparable diagnostic performance to CE for obscure GI bleeding, with added therapeutic benefits.
• Therapeutic DBE is crucial for managing Crohn's disease strictures, potentially reducing surgical needs.
• DBE provides a viable alternative to surgery for familial polyposis patients.
• Complication rates are low: ~1% for diagnostic and ~5% for therapeutic DBE.

Conclusions:

• Double-balloon endoscopy is a pivotal tool for diagnosing and treating diverse small bowel diseases.
• Its therapeutic capabilities, particularly in managing strictures and polyposis, offer significant advantages over traditional approaches.
• DBE is a safe and effective endoscopic modality with broad clinical applications.