Initial experience with double-balloon enteroscopy at a U.S. center

Background Double-balloon enteroscopy (DBE) allows direct visualization and intervention in the entire small intestine. Concerns include long procedure times and a long learning curve after training. Objectives To analyze the initial experience of a single endoscopist when using DBE; assess resource utilization, safety, clinical utility, and the learning curve. Design Prospective study. Setting Tertiary-referral center. Patients A total of 137 consecutive patients with bleeding or other small-intestine disorders. Main Outcome Measures Clinical impact at the time of DBE and changes in the procedure time and extent with experience. Results Two hundred DBE procedures were performed without major complications. For 115 oral DBEs, the mean (SD) procedure duration was 101 ± 35 minutes and length of examined small intestine was 220 ± 80 cm, with no significant change with experience. For 85 anal DBEs, the mean (SD) procedure duration was 96 ± 33 minutes, and the length examined was 124 ± 60 cm; the length examined increased with experience, but the duration did not decrease. The percentage of patients in which a DBE had a helpful clinical impact rose from 58% in the first 50 DBEs, to 86% in the last 50 of 200 DBEs. The total enteroscopy rose from 8% in the first 50 DBEs, to 63% in the last 50 of 200 DBEs. Limitations No follow-up data on outcomes. Conclusions DBEs required significant time and did not always allow for a total enteroscopy. DBEs were safe and helpful in the management of most patients. An experienced endoscopist may perform a safe and useful DBE after limited training, but the development of expertise may require more than 100 to 150 DBE procedures.