A Double Balloon Enteroscopy (DBE) is a specialized procedure used by gastroenterologists to visualize the small intestine. The small bowel is approximately 20 feet long, and its length and coiled structure make it difficult to examine fully using conventional endoscopy. Since standard endoscopes cannot reach past the first portion, and colonoscopies only reach the last portion, the DBE was developed to overcome this anatomical challenge. This advanced method uses a unique two-part system to navigate the small intestine, providing a direct view for diagnosis and treatment.
When a Double Balloon Enteroscopy is Needed
The primary reason for a Double Balloon Enteroscopy is to find the source of gastrointestinal bleeding that persists after negative results from an upper endoscopy and a colonoscopy. It is also used to diagnose and treat lesions causing chronic anemia or iron deficiency. Abnormal findings from imaging tests, such as a capsule endoscopy or CT scan, often lead to a DBE to confirm the diagnosis and allow for therapeutic intervention.
The enteroscopy allows physicians to manage conditions like small bowel tumors or polyps by obtaining tissue samples for biopsy or removing the growths entirely. It is also used to evaluate the extent of inflammatory bowel diseases, such as Crohn’s disease. Furthermore, the specialized scope can be used to treat strictures (areas of abnormal narrowing) or to remove foreign objects lodged within the digestive tract.
How the Double Balloon System Works
The Double Balloon Enteroscopy system allows for deep, controlled access into the small intestine using the “push-and-pull” technique. The system consists of a flexible endoscope, which has a camera and a balloon at its tip, housed inside a flexible overtube with a second balloon at its end. This paired equipment effectively shortens the small intestine onto the device.
The procedure begins with the endoscope and overtube advanced into the small bowel, either through the mouth or the anus. The first balloon on the endoscope tip is inflated to anchor it against the intestinal wall. The overtube is then pushed forward, gathering the intervening segment of the small intestine onto the overtube. The second balloon is inflated to secure the gathered segment. The first balloon is deflated, and the endoscope is advanced further. This cycle is repeated multiple times, allowing the physician to progressively insert the scope deep into the small intestine.
Steps to Prepare for the Procedure
The preparation required depends on the intended route of insertion. If the upper small intestine is the target (oral approach), the patient must fast, typically having no food for eight to twelve hours before the procedure. Clear liquids are allowed up to a few hours prior. If the focus is on the lower small intestine (anal approach), a complete bowel cleansing is required. This preparation is similar to a standard colonoscopy, involving a clear liquid diet and a laxative solution. Regardless of the route, patients must provide a complete list of their medications, as blood thinners or diabetes medications often need to be temporarily stopped or adjusted before the test.
What Happens During and Immediately After
A Double Balloon Enteroscopy is performed in a hospital or specialized outpatient endoscopy center under deep sedation or general anesthesia, which is necessary due to the procedure’s duration and complexity. The physician carefully guides the scope using the push-and-pull technique to visualize the small bowel lining. The duration often ranges from one to three hours, depending on the depth of insertion and any necessary therapeutic actions.
During the procedure, the physician may take biopsies, remove polyps, or cauterize bleeding lesions. Once the examination is complete, the patient is moved to a recovery area as the effects of the sedation wear off. Common immediate side effects include a mild sore throat (if the oral route was used) or abdominal bloating and discomfort from the air used to inflate the bowel. Patients are not permitted to drive home due to the sedation and must arrange for an escort.
Understanding Potential Procedure Risks
The Double Balloon Enteroscopy carries potential risks. One of the most significant risks is perforation, which is a tear in the wall of the small intestine. Studies suggest the overall rate of this complication is low, though it can increase up to three percent in patients who have previously had intestinal surgery or when the procedure is performed via the anal route.
Bleeding is another potential risk, particularly if therapeutic interventions like polyp removal or tissue sampling were performed during the examination. A rare complication associated mostly with the oral approach is acute pancreatitis, an inflammation of the pancreas. This risk is caused by mechanical irritation near the pancreatic duct opening, with an incidence of about 0.2 to 0.3 percent. There are also risks associated with the sedation or general anesthesia itself, such as respiratory or cardiac issues.