Future perspective of double balloon endoscopy: newer indications

Background: Double balloon endoscopy (DBE) is an emerging modality for complete endoscopic visualization of the small intestine. Although the most common indication of DBE is currently for evaluation of obscure GI bleeding or suspected small-bowel pathology, the unique technical features of the double balloon endoscope have led to its newer uses. Objective: To evaluate the utility of DBE by the retrograde approach to perform a complete evaluation of the colon. Patients: Sixteen patients in whom examination of the entire colon could not be achieved with conventional colonoscopy. Results: Using DBE by the retrograde approach, we achieved a high success rate of complete endoscopic examination of the entire colon, and we were also able to perform appropriate therapeutic interventions. The procedures were well tolerated by the patients and could be performed with the patient under conscious sedation and without the use of fluoroscopy. Limitations: This study comprised a small number of patients and there was no control group. Conclusions: Anecdotal data suggest that other areas in which DBE technology may be potentially helpful are ERCP in patients with surgically altered anatomy, and endoscopic evaluation of the bypassed segment of the upper GI tract in patients who have undergone bariatric surgery, but such applications will require the development of appropriate accessories and substantial technical modification to currently available instruments.