Double-balloon enteroscopy was developed by Yamamoto et al. about 20 years ago and entered the clinical field in beginning of the new Century [[1], [2], [3], [4], [5]]. The advent of double-balloon enteroscopy (DBE) was a major breakthrough for the diagnosis and treatment of small bowel disorders, but also disorders of the pancreatobiliary tract [[6], [7], [8], [9], [10]]. Soon thereafter single-balloon enteroscopy (SBE) was introduced [[11], [12], [13], [14]]. Both DBE and SBE have since replaced push enteroscopy as the preferred technique to investigate the small bowel. In contrast to push enteroscopy, when performing SBE and DBE the major factor governing the manoeuvrability and depth of insertion of the enteroscope is the presence of a balloon on the distal end of the flexible overtube. Therefore, we named this technique “balloon-assisted” enteroscopy (BAE) [15]. This terminology also permits the inclusion of the through-the-scope balloon into the spectrum of techniques encompassing BAE [16].

A few years later, spiral enteroscopy entered the field of small bowel endoscopy [17]. The concept of spiral enteroscopy is based on the use of an overtube, which has a thin, synthetic screw-like tube covering it. This configuration allows for “screwing” the overtube and the endoscope into the jejunum [17,18]. The original spiral enteroscopy overtube device is not in the market anymore, with motorized enteroscopy having since replaced it [19,20]. Because all modern deep enteroscopy methods rely on some sort of device, the term “device-assisted enteroscopy” (DAE) was coined [21]. In this narrative we present the technical aspects of performing DAE, focusing on indications and the evolving role of the technique and equipment.