Double balloon enteroscopy in Crohn's disease: where are we now and where should we go?

Visualization of the entire small-bowel mucosa had not been possible until the development of the capsule endoscope (Pillcam, Given Imaging, Yoqneam, Israel). However, this device did not allow any endoscopic intervention. More recently, a double balloon endoscope has been developed that allows intubation of the entire small bowel. This endoscope contains a working channel that allows for all the interventions possible with standard colonoscopes. In this review we describe the instrument, techniques for its use, and its practical applications and capabilities. We review the experience to date for its use in various clinical indications for small-bowel inflammatory disease, its diagnostic and therapeutic yield and risks, and its role and potential in the diagnosis and treatment of inflammatory bowel disease.