Complications in and performance of double-balloon enteroscopy (DBE): results from a large prospective DBE database in Germany

Background and study aims: Double-balloon enteroscopy (DBE) has been established as an invaluable tool for the diagnosis and treatment of small-bowel diseases. To evaluate complications, procedural data, and diagnostic yield of DBE examinations in Germany the presented database was introduced. Methods: A prospective database of all DBE examinations in 62 endoscopic centers in Germany was developed using data from a standard questionnaire. Information requested included data on personal information, indications, procedural information, interventions, diagnostic yield, and complications. Results: In total, 2245 DBE examinations in 1765 patients were reported prospectively over a 2-year period. The most frequent indication was overt or occult bleeding in the small intestine and the most frequent intervention was argon plasma coagulation of angiodysplasia. The rate of complete enteroscopy was only 23%. A clear dependency of indication and diagnostic yield could be documented, ranging widely from a diagnostic yield of 16% in patients with abdominal pain and 82% in patients with Peutz-Jeghers syndrome. A total of 27 complications produced a complication rate for all examinations of 1.2%. Pancreatitis was diagnosed in four cases (0.3% of oral-route DBE). Perforations occurred in three patients, two of whom had undergone polypectomy in the small bowel (1.5% of 137 polypectomies). Conclusion: DBE is a safe endoscopic technique according to this large prospective database, with a complication rate of 1.2%. The diagnostic yield of DBE examinations depends upon the quality of indication, and is very low in patients with the single indications of diarrhea or abdominal pain.