Indications, diagnostic yield, and complication rate of balloon-assisted enteroscopy during the first decade of its use in Korea Sung Noh Hong, 1 Eun Ran Kim, 1 Byong Duk Ye, 2 Hyun Joo Jang, 8 Seong Ran Jeon, 3 Soo Jung Park, 4 Jong Pil Im, 5 Jeong Hwan Kim, 6 Chang Hwan Choi, 7 Hwang Choi, 9 Dong Kyung Chang 1 and Small Intestine Research Group of the Korean Association for the Study of Intestinal Diseases (KASID) 1 Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 2 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 3 Department of Internal Medicine, Soonchunhyang University College of Medicine, 4 Department of Internal Medicine, Yonsei University College of Medicine, 5 Department of Internal Medicine, Seoul National University College of Medicine, 6 Department of Internal Medicine, Konkuk University School of Medicine, 7 Department of Internal Medicine, Chung- Ang University College of Medicine, Seoul, 8 Department of Internal Medicine, Hallym University College of Medicine, Hwaseong, and 9 Department of Internal Medicine, The Catholic University of Korea College of Medicine, Incheon, South Korea Background and Aim: Previous studies that addressed the outcome of balloon-assisted enteroscopy (BAE) were based on its early experience. The accumulated BAE experience over the last decade might affect its pattern of use and outcome. In order to evaluate the changes of BAE practice over time, we compared the indications, diagnostic yield, and complication rate between the early and late stages of BAE implementation. Methods: This multicenter study analyzed BAE-related factors of 1108 BAE procedures carried out in 860 patients and compared BAE done at an earlier stage (January 2004–August 2008) to those carried out at a later stage (September 2008–February 2013). Results: The most common indication for BAE was obscure gas- trointestinal bleeding (58.3%). In the early stage, BAE to assess un- explained symptoms/signs was more common (18.8% vs 9.7%), whereas BAE to confirm abnormal findings of imaging studies was more common in the late stage (9.4% vs 18.8%, P < 0.001). Overall diagnostic yield of BAE was 74.6% (95% CI, 72.0–77.1%). There was no significant difference in the diagnostic yield be- tween the early and late stages (72.2% vs 77.0%, P = 0.073). BAE- associated complications occurred in 12 procedures (1.1%; 95% CI, 0.6–1.9%). The complication rate decreased significantly in the late stage compared to that during in the early stage (1.8% vs 0.4%, P = 0.020). Conclusion: BAE is a safe and useful tool for the diagnosis and management of small bowel disease. With time, the indications for BAE have become more specific and the BAE-associated com- plication rate has decreased. Key words: balloon-assisted enteroscopy, complication rate, diagnostic yield, double balloon enteroscopy, indication INTRODUCTION B ALLOON-ASSISTED ENTEROSCOPY (BAE) allows the endoscopist not only to visualize the small bowel (SB), but also to take biopsies, dilate strictures, remove polyps, and terminate bleeding, as appropriate. 1–4 Double balloon enteroscopy (DBE) was developed in 2001 and is considered the standard form of BAE. 1 Single balloon enteroscopy (SBE) was introduced in 2007 as a simplification of DBE. 5 In Korea, DBE has been available since 2004, and SBE since 2008. This technology has now been used in clinical practice for over a decade. The diagnostic yield for BAE surpasses that of other imag- ing modalities. In addition, BAE allows therapeutic intervention. 3,4 Early after its introduction, the use of BAE was limited by lengthy procedure times, technical difficulties, Corresponding: Dong Kyung Chang, Division of Gastroenterology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Email: dkchang@skku.edu Received 2 June 2015; accepted 16 December 2015 © 2015 Japan Gastroenterological Endoscopy Society 443 Digestive Endoscopy 2016; 28: 443–449 doi: 10.1111/den.12593 Original Article