Small-bowel inflammatory lesions are challenging to diagnose thanks to their anatomical complexity and the limitations of conventional imaging. Double-balloon enteroscopy (DBE) allows for direct visualization, biopsy, and therapeutic intervention. This study evaluated the diagnostic yield and clinical impact of DBE in small-bowel inflammatory lesions, particularly in differentiating Crohn's disease (CD) from other etiologies. This retrospective study included 258 patients who underwent DBE for suspected small-bowel inflammatory lesions at Dokuz Eylül University Hospital (2010-2024). Patients were categorized into the CD and non-CD groups. The clinical, radiological, and endoscopic findings were also analyzed. Statistical comparisons were performed to assess the differences in presentation and DBE findings between the groups. The mean patient age was 48.2 ± 17.3 years. Abdominal pain (47.7%) and diarrhea (31.8%) were the most common symptoms. The DBE findings included ulcers (45.0%), superficial mucosal changes (23.3%), and strictures (9.7%). The ileum was the most commonly affected site (31.7%). CD was diagnosed in 27.5% of the patients, while other etiologies included non-steroidal anti-inflammatory drug-induced (NSAID) enteropathy (12.0%) and malignancies (15.9%). Ulcers were significantly more frequent in patients with CD than in those without (60.3% vs. 39.0%, = 0.002). DBE plays a crucial role in diagnosing small-bowel inflammatory lesions, distinguishing CD from other conditions, and guiding clinical management. It remains essential for cases requiring histopathological confirmation, offering superior diagnostic accuracy compared to noninvasive imaging.