Until the development of wireless
capsule endoscopy (CE) and double-balloon enteroscopy (DBE), it was extremely difficult to examine the entire small intestine. To assess the usefulness of DBE for diagnosing suspected small intestinal
bleeding, we retrospectively compared the diagnoses and treatments of cases before and after its introduction at one hospital. Between September 2003 and December 2005, 21 consecutive patients with suspected small intestinal
bleeding underwent DBE at Tokai University Hospital (group A), and subsequently 2 were excluded from the study after being diagnosed with
bleeding from a
diverticulum and an
angiodysplasia in the ascending colon, respectively. For comparison, inpatients who were negative for gastrointestinal
bleeding on colonoscopy and gastroscopy between May 1998 and August 2003 were reviewed and 27 consecutive patients who had not undergone DBE were selected as the control group (group B). All patients had been diagnosed negative for a source of
bleeding on more than one colonoscopy and gastroscopy. There were no significant differences between the two groups in terms of age, gender, history of
blood transfusion, blood
hemoglobin value on admission, or symptoms. The diagnostic yield of DBE in identifying the source of
bleeding was 78.9%: six cases of small intestinal
ulcers, five cases of
angiodysplasia, two cases of hard submucosal
tumor (SMT), one case of small pulsating SMT, and one case of small
intestinal cancer. DBE was also used to successfully treat three cases of
angiodysplasia with
argon plasma coagulation. In the control group, conventional investigations, including enteroclysis, angiography, Meckel scan, scintigraphy with
technetium-labeled red blood cells, and/or push enteroscopy, were performed in 88.9%, 29.6%, 29.6%, 55.6%, and 25.9%, respectively. The overall diagnostic yield of the conventional approaches was only 11.1% (P < 0.01), comprising a
Meckel's diverticulum, a
polyp, and an
angiodysplasia. We conclude that DBE can be used to diagnose suspected small intestinal
bleeding and to treat some cases, such as
angiodysplasia.