Reply to Xin et al.

We thank Xin et al. for their comments. We agree that the definitions of complete enteroscopy are heterogeneous. The definition of the complete enteroscopy rate in double-balloon endoscopy (DBE) examinations as the ratio of cases with DBE successfully passing through the entire small bowel over the total number of cases in which attempts to examine the entire small bowel are made was used in our database to describe the complete enteroscopy rate of 21 %. The 23 % used in the discussion section is an error, for which we apologize.

We discussed the impact of pathologic findings in the attempt to examine the entire small bowel in our group. It is possible that pathologic findings have a negative impact on the motivation of the examiner during the second examination to reach the tattoo marking of the day before. To eliminate this influence from our data we additionally explored whether or not the rate of complete enteroscopy in the group of patients with pathologic findings differed from the group of patients without pathologic findings. In 230 of 436 patients in whom attempts were made to examine the entire small bowel by the combined approaches, both examinations were stated to be normal. Interestingly, the rate of complete enteroscopy in this subgroup of patients was lower than the rate in patients with pathologic findings (20 % vs. 22 %); there was no significant difference between the groups. So it is possible that in contrast to the hypothesis mentioned above, the motivation of the examiner is influenced in a negative way by a normal first examination. To conclude, we think that it is reasonable to mention not only the overall complete enteroscopy rate but also to divide this rate into the rates for patients with and without pathologic findings.