Therapeutic uses of double-balloon enteroscopy.

In spite of initial skepticism toward the practicability of double-balloon enteroscopy, this technology will become an integral part of endoscopy and is likely to find expanded applications in the future. One strong reason to support this technique is the capacity to deliver endoscopic therapies, and thereby minimize aggressive surgical options. With increasing acceptance of capsule endoscopy by the medical community, more small-bowel lesions will be found and more directed endoscopic interventions will be needed. Like many new procedures, reimbursement issues will possibly prevent it from gaining well-deserved popularity. Unlike other common endoscopies, double-balloon enteroscopy is an expensive procedure. It requires fluoroscopy, extended anesthesia support, long procedure time, significant capital investment, and a team of threeor four people (endoscopist, anesthesiologist, nurse). Gastroenterologists and their patients will have to work together to convince insurance carriers that this isa valuable and cost-effective technology worthy of appropriate reimbursement.