Foreword: double balloon endoscopy

Foreword: double balloon endoscopy The idea of the ‘‘double balloon method’’ came to mind in 1997, when I encountered a patient with obscure GI bleeding for whom push enteroscopy had failed because the bleeding source was beyond the reach of the enteroscope. Although capsule endoscopy was under development at the same time and appeared to be a promising technique for the examination of the entire small intestine, I believed that an enteroscopic technique that could examine the entire small intestine and treat any identified lesions would be necessary. As I started to analyze the reasons for the difficulty of endoscopic insertion in push enteroscopy, I realized that the main challenge was the stretchable nature of the small intestine. I therefore tried to prevent stretching of a curved segment of the small intestine with a soft overtube with a balloon to assist better insertion of the endoscope. I also used another balloon at the tip of the endoscope to prevent withdrawal of the endoscope tip while advancing the overtube. Using these 2 balloons in turn, I found the endoscope tip could be inserted further into the small intestine while shortening the small intestine onto the overtube. This double balloon method accomplished a much better insertion length than push enteroscopy and enabled endoscopic observation of the entire small intestine. Another remarkable feature of the double balloon method was its controllability. Precise control of the endoscope tip was possible using the double balloon method, even at the distal small intestine, because it was controlled from the stabilized point by the overtube balloon, which could be located close to the endoscope tip. This endoscopy system using the double balloon method was developed and released to the market in Europe, China, and Japan in the autumn of 2003. Now, thanks to enthusiastic colleagues in several countries, double balloon endoscopy is recognized as useful and is used in more than 40 countries. Through the spread of its use, a large clinical experience has been collected, both in the diagnosis and the treatment of small intestinal diseases. In order to share the experiences of endoscopists from around the world and reach consensus on technical and medical issues related to double balloon endoscopy, the First International Workshop on Double Balloon Endoscopy was held on August 4 and 5, 2006 in Tokyo. One hundred and seventy-nine participants, from 27 countries, who were interested in double balloon endoscopy gathered, and

a consensus meeting took place among the organizing committee members of the workshop on August 4. On August 5, we held the main programs of the workshop, with 4 sessions of presentations and discussions in 1 day. The discussions concerned technical matters and medical questions. During the morning, the current status and future perspectives of double balloon endoscopy were discussed. In the afternoon, discussions were held concerning medical questions that focused on obscure GI bleeding, Crohn’s disease, and other related disorders. Six speakers from around the world presented their views at each session, with lively discussions. Because our main objective was to have participants from various regions share their experiences on the same subjects and reach consensus, these 6 speakers made presentations on the same topic. During the workshop, the participants ascertained whether they shared a common viewpoint on the material, and discussions focused on points on which they did not agree. We thereby achieved consensus through continuous discussions. We all became convinced that double balloon endoscopy can improve medical care of patients with small intestinal diseases as well as can change their prognosis and management. Although double balloon endoscopy was developed for the small intestine, it is also useful for difficult colonoscopic examinations and for the evaluation of surgically bypassed intestine, such as in patients with Roux-en-Y anastomosis. This supplement issue of Gastrointestinal Endoscopy summarizes the discussions made at the Tokyo workshop and will unquestionably help clinicians understand this relatively new field of endoscopy.

DISCLOSURE The author Dr Yamamoto, has applied for the patent in Japan on the double balloon endoscopy described in this article. Hironori Yamamoto, MD Chairman, 1st International Workshop on Double Balloon Endoscopy Division of Gastroenterology Department of Internal Medicine Jichi Medical University Tochigi, Japan

Copyright ª 2007 by the American Society for Gastrointestinal Endoscopy 0016-5107/$32.00 doi:10.1016/j.gie.2007.01.007

S2 GASTROINTESTINAL ENDOSCOPY Volume 66, No. 3 : 2007

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