Double-balloon endoscopy has been available for investigation of the small bowel since 2001, concomitantly with capsule endoscopy. Beyond established indications, endoscopic examination of the small bowel is currently performed in many clinical conditions involving the small bowel, which were under investigated in the past. Biopsies of lesions observed by capsule endoscopy or balloon enteroscopy can be taken and the lesions can sometimes be treated during a balloon Endoscopic procedure. Double-balloon endoscopy can be used in patients when conventional endoscopy was incomplete. The main applications of double-balloon endoscopy are the examination of patients with a surgically modified gastrointestinal tract and colonoscopy after a previously failed attempt to reach the cecum. In the latter indication, using a dedicated double-balloon colonoscope, the success rate of cecal intubation may be nearly 100%.