Introduction

The human digestive system is a complex network of organs, each with a specific role to play in the digestion and absorption of nutrients.

While the stomach, small intestine, and large intestine are well-known players in this process, there’s one organ that often remains unseen and unexplored: the small intestine.

Measuring around 20 feet in length, the small intestine is a crucial part of the digestive system, yet its deep location has made it challenging to examine.

In this guide, we will explore the fascinating world of the small intestine and discuss a remarkable tool for investigating it: double balloon enteroscopy.

Understanding the Small Intestine

The small intestine is where the majority of nutrient absorption takes place.

It is divided into three sections: the duodenum, the jejunum, and the ileum.

Despite its essential role, the small intestine has historically been challenging to examine due to its length, intricate folds, and deep location within the body.

What Is Double Balloon Enteroscopy?

Double balloon enteroscopy (DBE) is a specialized endoscopic procedure that allows healthcare providers, typically gastroenterologists, to access and visualize the small intestine.

It is named for the use of two balloons – one on the endoscope and another on an overtube – which work together to advance and anchor the endoscope through the small intestine.

DBE is performed to diagnose and treat various small intestine conditions, such as Crohn’s disease, small bowel tumors, and unexplained gastrointestinal bleeding.

It is a minimally invasive procedure that offers significant advantages over traditional diagnostic methods, such as surgery.

When Is Double Balloon Enteroscopy Used?

Diagnostic Applications:

1. Obscure Gastrointestinal Bleeding: DBE is especially valuable in diagnosing obscure gastrointestinal bleeding, where the source of bleeding is challenging to identify through other imaging techniques.
2. Suspected Small Bowel Tumors: When small bowel tumors are suspected, DBE can provide a direct view of the lesions and collect tissue samples for biopsy.
3. Evaluation of Crohn’s Disease: DBE is used to assess the extent and severity of Crohn’s disease in the small intestine, aiding in disease management and treatment planning.
4. Unexplained Abdominal Pain: For individuals with chronic unexplained abdominal pain, DBE can help identify sources of discomfort within the small intestine.

Therapeutic Applications:

1. Polyp and Tumor Removal: During DBE, gastroenterologists can remove small polyps and tumors from the small intestine, eliminating potential sources of future complications.
2. Stricture Dilation: Strictures or narrowing in the small intestine can be dilated or stretched during DBE to relieve obstructions and improve the flow of food and liquids.
3. Stent Placement: In cases of blockages or strictures, stents can be placed to maintain the patency of the small intestine and alleviate symptoms.

How Double Balloon Enteroscopy Works

The DBE procedure begins with the patient receiving sedation to ensure comfort and relaxation. Here is an overview of the key steps involved:

1. Insertion: The endoscope, equipped with one balloon, is introduced through the mouth or rectum and guided into the small intestine.
2. Balloon Inflation: The balloon on the endoscope is inflated to anchor it in place, while the overtube is advanced further into the small intestine.
3. Advancement: The overtube is moved ahead, pushing the endoscope deeper into the small intestine.
4. Visualization: The endoscope provides real-time images of the small intestine’s lining, allowing the gastroenterologist to closely examine the tissue and identify any abnormalities.
5. Intervention: If polyps, tumors, or strictures are encountered, they can be treated during the procedure. This may involve removal, dilation, or stent placement, depending on the issue.
6. Biopsy: Tissue samples (biopsies) can be collected for further analysis if necessary.

What to Expect During a Double Balloon Enteroscopy

Before the procedure, you’ll receive specific instructions on preparation, which typically involves fasting and bowel preparation.

During the procedure:

• You will be given sedation for comfort.
• The procedure may take anywhere from 30 minutes to a few hours, depending on the extent of the examination and any interventions required.

After the procedure, you will be monitored until the sedation wears off. You may experience some mild abdominal discomfort, bloating, or cramping, which should subside within a day.

Recovery and Aftercare

The recovery period following a DBE is relatively short.

Patients are typically able to resume their regular diet and activities the same day, although some may prefer to take it easy for a day or two.

The results of the procedure and any biopsies taken will be reviewed by your healthcare provider, who will discuss the findings and any necessary treatment or follow-up plans.

What are the risks of DBE?

Double balloon enteroscopy (DBE) is generally considered a safe and well-tolerated procedure.

However, like any medical procedure, it carries some inherent risks and potential complications.

These risks are typically low but need to be considered. It’s important for patients to be aware of these risks and discuss them with their healthcare provider before undergoing DBE.

Some of the potential risks and complications associated with DBE include:

1. Bleeding: During DBE, biopsies may be taken, or polyps and tumors may be removed. In some cases, this can lead to bleeding. The majority of bleeding cases can be managed during the procedure, but there is a small risk of post-procedure bleeding, which might require further intervention.
2. Perforation: Although rare, there is a risk of a small tear or perforation in the lining of the small intestine. Perforations can occur during the passage of the endoscope or during therapeutic interventions like polyp or stricture removal. Perforations are typically managed with immediate medical attention and, in some cases, surgical repair.
3. Infection: Any time an invasive procedure is performed, there is a small risk of infection. To minimize this risk, DBE is performed in a sterile environment, and strict infection control protocols are followed.
4. Reaction to Sedation: Sedative medications are administered to keep the patient comfortable and relaxed during the procedure. While these medications are generally safe, there is a small risk of an adverse reaction, such as an allergic reaction or breathing difficulties. It’s crucial for the healthcare team to monitor the patient’s condition during the procedure to address any potential complications promptly.
5. Incomplete Examination: In some cases, it may not be possible to advance the endoscope through the entire small intestine. This can result in an incomplete examination and limit the ability to visualize certain areas of the small intestine. The reasons for an incomplete examination can vary, including anatomical factors or patient discomfort.
6. Post-Procedure Discomfort: Patients may experience mild abdominal discomfort, bloating, or cramping following the procedure. This discomfort is usually short-lived and should resolve within a day.

It’s essential for patients to discuss these risks and any specific concerns with their healthcare provider before undergoing DBE.

Healthcare providers will assess the individual’s medical history and determine the appropriateness of the procedure based on their unique circumstances.

Conclusion: Illuminating the Unseen with Double Balloon Enteroscopy

Double balloon enteroscopy is a remarkable advancement in the field of gastroenterology, providing healthcare providers with the means to explore and treat the small intestine.

With its diagnostic and therapeutic capabilities, DBE offers hope to individuals with small bowel conditions, including those with unexplained gastrointestinal bleeding, suspected tumors, or Crohn’s disease.

If you’re experiencing symptoms related to your small intestine or have been recommended for a DBE procedure, remember that this specialized tool can illuminate the unseen and pave the way for diagnosis, treatment, and ultimately, improved health and well-being.

Contact Dr. Deetlefs

Dr Eduan prides himself on his ability to help his patients to the best of his ability by embracing good listening skills, effective communication, compassion and knowledge and skill honed during years of private gastroenterology practice.

If you would like to book an appointment with a gastrointestinal (GI) specialist or would simply like more information on a particular GI topic, don’t hesitate to use our online booking form or call Dr. Deetlefs at 021 551 867. 

Double-Balloon Enteroscopy Overview

Double balloon enteroscopy (DBE) is a specialized endoscopic procedure that enables visualization and treatment of the small intestine, which is often difficult to access with traditional endoscopy techniques.

The procedure involves the use of a specialized endoscope that has two balloons attached to it – one at the tip of the endoscope and the other at the overtube.

The endoscope is passed through the patient’s mouth or anus, depending on which part of the small intestine needs to be examined.

The process works as follows:

• The first balloon is inflated, anchoring the overtube in place.
• The second balloon, located at the tip of the endoscope, is advanced further into the small intestine and then inflated.
• The first balloon is deflated, allowing the overtube to be moved forward.
• This process is repeated, with the alternating inflation and deflation of the balloons, allowing the endoscope to “pleat” or “shorten” the small intestine, making it easier to visualize and access.

Double balloon enteroscopy is useful in diagnosing and treating various conditions of the small intestine, such as bleeding, tumors, inflammatory bowel disease, and other abnormalities.

The procedure can also be used to obtain tissue samples for biopsy or to perform therapeutic interventions like polyp removal, dilating strictures, or treating bleeding lesions.

As with any invasive procedure, there are risks associated with double balloon enteroscopy, such as bleeding, perforation, or infection.

However, it is generally considered a safe and effective method for evaluating the small intestine when performed by an experienced endoscopist.

Reasons For a Double-Balloon Enteroscopy

Double-balloon enteroscopy (DBE) is a valuable tool for diagnosing and treating various conditions involving the small intestine.

It is typically performed when other diagnostic methods, such as standard upper and lower endoscopies, capsule endoscopy, or imaging studies, have not provided a definitive diagnosis or when therapeutic intervention is required.

Some common reasons for a double-balloon enteroscopy include: 

• Obscure gastrointestinal bleeding: DBE is often used to identify the source of gastrointestinal bleeding when it cannot be found using conventional endoscopy or imaging studies. This type of bleeding can be caused by vascular malformations, small bowel tumors, or ulcers.
• Inflammatory bowel disease (IBD): DBE can help diagnose and evaluate the extent of IBD, such as Crohn’s disease, in the small intestine, particularly when other imaging studies are inconclusive or insufficient.
• Small bowel tumors: DBE can be used to visualize and biopsy small bowel tumors, such as gastrointestinal stromal tumors (GISTs), adenocarcinomas, or lymphomas, which are difficult to reach with conventional endoscopy.
• Polyps and polyposis syndromes: DBE can be used to diagnose and treat polyps or polyposis syndromes, such as Peutz-Jeghers syndrome, in the small intestine.
• Small bowel strictures: DBE can help identify and treat strictures or narrowing in the small intestine caused by conditions such as Crohn’s disease, radiation enteritis, or surgical adhesions.
• Malabsorption syndromes: DBE can be used to evaluate and diagnose malabsorption syndromes, such as celiac disease or Whipple’s disease, when other diagnostic methods are inconclusive.
• Retrieval of foreign bodies or retained capsules: In some cases, DBE can be used to retrieve foreign bodies or endoscopy capsules that have become lodged in the small intestine.
• Gastrointestinal fistulas or abnormal connections: DBE can help identify and evaluate fistulas between the small intestine and other organs or structures.

It is essential to note that the decision to perform a double-balloon enteroscopy is made on a case-by-case basis, considering the patient’s medical history, symptoms, and the results of prior diagnostic tests.

Preparing for a Double-Balloon Enteroscopy

Preparing for a double-balloon enteroscopy (DBE) is an essential step to ensure the procedure’s success and minimize potential complications.

Your healthcare provider will give you specific instructions on how to prepare, which may vary depending on whether the DBE is performed via the oral (antegrade) or anal (retrograde) approach.

Here are some general guidelines for preparing for a DBE:

Diet and fasting:

You may be asked to follow a clear liquid diet for a day or two before the procedure. Clear liquids include water, clear broth, apple juice, plain tea, or black coffee.

You will likely be instructed to stop consuming any food or drink after midnight on the day before the procedure.

This ensures that your stomach and small intestine are empty during the examination.

Bowel preparation:

For an antegrade DBE (through the mouth), bowel preparation is usually not required.

For a retrograde DBE (through the anus), bowel preparation is essential. You will be given instructions on using a laxative solution or enema to clean out your colon.

This may involve drinking a large volume of a prescribed solution or taking over-the-counter laxatives. Follow your doctor’s instructions carefully to ensure your colon is adequately cleansed.
 

Medications:

Inform your healthcare provider about any medications you are taking, including prescription medications, over-the-counter drugs, vitamins, or herbal supplements.

You may be asked to stop or adjust the dosage of certain medications, such as blood thinners, nonsteroidal anti-inflammatory drugs (NSAIDs), or diabetes medications, before the procedure.

Always consult your healthcare provider before making any changes to your medications.

Allergies:

Inform your healthcare provider if you have any allergies, particularly to medications, latex, or iodine, as these substances may be used during the procedure.

Sedation and anesthesia:

DBE is typically performed under conscious sedation or general anaesthesia, depending on the individual patient and the facility where the procedure is conducted.

Discuss your sedation or anaesthesia options with your healthcare provider and inform them of any previous adverse reactions to sedatives or anaesthetics.

Arrange transportation: 

Since you will be sedated for the procedure, you will not be able to drive yourself home afterward. Arrange for a friend or family member to accompany you and provide transportation.

Remember to follow your healthcare provider’s instructions carefully to ensure the best possible outcome from your double-balloon enteroscopy.

If you have any questions or concerns about the preparation process, don’t hesitate to contact your healthcare provider for clarification.

The Recovery After Double-Balloon Enteroscopy

Recovery after a double-balloon enteroscopy (DBE) may vary depending on the individual patient, the extent of the procedure, and whether any therapeutic interventions were performed during the examination.

Here are some general guidelines for the recovery process:

Post-procedure monitoring:

Immediately after the procedure, you will be taken to a recovery area where your vital signs, such as blood pressure, heart rate, and oxygen levels, will be monitored as the sedation or anesthesia wears off. 

You may experience mild drowsiness, dizziness, or disorientation due to the sedative medications. These effects should resolve as the sedation wears off.
 

Discharge Instructions:

Once you are fully awake and stable, you will be given discharge instructions. These may include guidelines on resuming your regular diet, medications, and activities. 

You may be advised to avoid driving or operating heavy machinery for 24 hours after the procedure due to the lingering effects of sedation.

Side effects and complications:

You may experience mild bloating, gas, or abdominal discomfort after the procedure.

These symptoms are usually temporary and should resolve within a few hours to a day.

Although rare, complications can occur after a DBE, including bleeding, infection, or perforation. If you experience any of the following symptoms, contact your healthcare provider immediately:

• Severe abdominal pain
• Fever or chills
• Persistent vomiting
• Bloody or black, tarry stools
• Shortness of breath or chest pain

Follow-up appointments:

Your healthcare provider will typically schedule a follow-up appointment to discuss the results of the DBE and any biopsy results if tissue samples were taken during the procedure.

If therapeutic interventions were performed, such as polyp removal or stricture dilation, your healthcare provider will discuss the appropriate follow-up care, including any additional testing or treatment that may be required.

In general, most patients recover quickly after a double-balloon enteroscopy and can return to their normal activities within a day or two.

However, your individual recovery time may vary depending on your overall health and the specifics of your procedure.

Always follow your healthcare provider’s instructions and recommendations for the best possible outcome. 

Conclusion

Dr. Deetlefs has earned the reputation of a trusted health expert providing consultative, diagnostic, and therapeutic endoscopic and related services to patients in Cape Town and beyond.  

Dr Eduan prides himself on his ability to help his patients to the best of his ability by embracing good listening skills, effective communication, compassion and knowledge and skill honed during years of private gastroenterology practice.

If you would like to book an appointment with a gastrointestinal (GI) specialist or would simply like more information on a particular GI topic, don’t hesitate to use our online booking form
or call Dr. Deetlefs at 021 551 867.