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Navigating the Unseen: A Guide to Double Balloon Enteroscopy

Navigating the Unseen: A Guide to Double Balloon Enteroscopy

 
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.

 

DBE_small_intestine

 

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.

 

double_balloon_enteroscopy_procedure

 

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_after_dbe

 

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.

 

double_balloon_enteroscopy_infographic


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. 

DISCLAIMER: PLEASE READ CAREFULLY

The information on this website is to provide general guidance. In no way does any of the information provided reflect definitive medical advice and self-diagnoses should not be made based on information obtained online. It is important to consult a Gastroenterologist or medical doctor regarding ANY and ALL symptoms or signs including, but not limited to: abdominal pain, haemorrhoids or anal / rectal bleeding as it may a sign of a serious illness or condition. A thorough consultation and examination should ALWAYS be performed for an accurate diagnosis and treatment plan. Be sure to call a physician or call our office today and schedule a consultation.

GIDoc Cape Town

Patient-focused GI treatments and procedures in Cape Town.

Monday-Friday 8AM-4PM.

Connect with Us

© Dr. Eduan Deetlefs, Registered Gastroenterologist, GI Doc Cape Town

Our website information is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a doctor about your specific condition. Only a trained physician can determine an accurate diagnosis and proper treatment.

Exploring ERCP: A Comprehensive Guide

Exploring ERCP: A Comprehensive Guide

This versatile and powerful procedure has revolutionized the field of gastroenterology, allowing healthcare professionals to diagnose and treat a wide range of conditions affecting the bile ducts, pancreas, and gallbladder.

In this comprehensive guide, we will delve into the world of ERCP, exploring its uses, benefits, procedure, potential risks, and much more.

Understanding ERCP: What Is It?

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a specialized medical procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions in the bile ducts, pancreas, and gallbladder.

It provides detailed images and, if necessary, allows for the performance of therapeutic interventions. ERCP is typically performed by a gastroenterologist, a specialist in digestive diseases.

The Key Components of ERCP

Endoscope: An endoscope is a flexible, tube-like instrument equipped with a light source and a camera. It is inserted through the mouth, down the esophagus, and into the stomach and duodenum (the first part of the small intestine).

Fluoroscopy: Fluoroscopy is a real-time X-ray imaging technique that provides dynamic images of the bile ducts and pancreatic duct.

Contrast Medium: A contrast medium, often a special dye, is injected into the ducts to make them visible on X-ray images.

ercp_procedure

When Is ERCP Used?

ERCP is employed for various diagnostic and therapeutic purposes, primarily related to the digestive system. Some common indications for ERCP include:

  1. Diagnosing and Treating Gallstones:

ERCP can identify gallstones trapped in the bile ducts, causing symptoms like jaundice, abdominal pain, and pancreatitis (inflammation of the pancreas). In such cases, the stones can be removed during the procedure.

  1. Diagnosing and Managing Biliary and Pancreatic Tumors:

ERCP can help in evaluating and diagnosing tumors or strictures (narrowing) in the bile ducts or pancreatic duct. It can also assist in placing stents to relieve blockages caused by these conditions.

  1. Treating Pancreatitis:
    In some cases of acute pancreatitis, ERCP may be performed to remove obstructions or perform other therapeutic procedures.
  1. Draining Fluid Collections:

ERCP can be used to drain fluid collections (pseudocysts) in the pancreas or bile ducts.

  1. Evaluating Chronic Abdominal Pain:
    When the cause of chronic abdominal pain is unclear, ERCP can be used as a diagnostic tool to explore the pancreas and bile ducts.
  1. Roux-en-Y Gastric Bypass Procedures:
    In patients who have previously undergone gastric bypass surgery, ERCP can be challenging. However, specialized techniques, such as laparoscopy-assisted or double-balloon-assisted ERCP, have been developed to access the desired areas.

ercp_balloon_enteroscopy

The ERCP Procedure: What to Expect

Before undergoing ERCP, patients are typically given instructions about fasting to ensure an empty stomach. The procedure is performed in a hospital or outpatient endoscopy center and generally follows these steps:

  1. Preparation:

Patients may receive a sedative or anesthesia to relax and minimize discomfort during the procedure. The throat is also numbed with a local anesthetic to ease the insertion of the endoscope.

  1. Insertion of the Endoscope:

The gastroenterologist carefully inserts the endoscope through the mouth and into the esophagus, stomach, and duodenum.

  1. Locating the Papilla:

The papilla of Vater, a small nipple-like structure where the common bile duct and pancreatic duct drain into the duodenum, is located using the endoscope.

  1. Contrast Injection:

A contrast medium (dye) is injected into the ducts to make them visible on X-ray images. Fluoroscopy is used to monitor the movement of the contrast medium.

  1. Imaging and Diagnosis:

X-ray images are captured in real-time to evaluate the structure and function of the bile ducts and pancreatic duct. If any abnormalities are detected, they can be further examined or treated during the same procedure.

  1. Therapeutic Procedures:

ERCP allows for various therapeutic interventions, such as removing gallstones, placing stents, widening strictures, or draining fluid collections. These procedures can alleviate symptoms and improve overall health.

  1. Completion:

Once the necessary diagnostic or therapeutic steps are completed, the endoscope is carefully removed.
The duration of an ERCP can vary but typically takes between 30 minutes to an hour. After the procedure, patients are monitored in a recovery area until the sedation wears off, and it is safe to be discharged.

Potential Risks and Complications of ERCP

While ERCP is generally considered a safe and effective procedure, like any medical intervention, it carries some risks and potential complications.

These can include:

  1. Pancreatitis: This is one of the most common complications of ERCP. Pancreatitis is inflammation of the pancreas and can range from mild to severe. It can cause abdominal pain, nausea, vomiting, and in severe cases, may require hospitalization. The risk of pancreatitis following ERCP varies but is generally around 5% to 10%. It is more common when therapeutic interventions, such as sphincterotomy (cutting of the sphincter), are performed during the procedure.
  2. Infection: Infections can occur in rare cases, either in the bile ducts or the pancreas. Bacterial infection can lead to symptoms such as fever, chills, and abdominal pain. Infection risk is minimized by following strict sterile techniques during the procedure.
  3. Bleeding: Although uncommon, bleeding can occur during or after ERCP, particularly if therapeutic procedures like sphincterotomy or stone removal are performed. Minor bleeding may resolve on its own, but significant bleeding may require additional interventions or surgery.
  4. Perforation: Perforation, or a tear in the digestive tract, is a rare but serious complication. It can lead to abdominal pain, infection, and the leakage of digestive contents into the abdominal cavity. Emergency surgery is usually necessary to repair a perforation.
  5. Allergic Reaction: Some patients may experience an allergic reaction to the contrast medium used during ERCP. Allergic reactions can range from mild skin rashes to more severe symptoms like difficulty breathing or anaphylaxis. The risk of a severe allergic reaction is relatively low.
  6. Complications Related to Anesthesia: Sedatives and anesthesia used during ERCP carry inherent risks, including respiratory depression, reduced oxygen levels, and reactions to medications. These risks are typically minimized by careful monitoring during the procedure.
  7. Other Risks: There is also a slight risk of complications such as blood clots, heart problems, or adverse reactions to medications used during ERCP.

It’s important to note that while these risks are associated with ERCP, the procedure is generally considered safe and effective when performed by experienced gastroenterologists or endoscopists.

 ercp_after_procedure

Recovery and Aftercare

After an ERCP, patients are typically monitored for a brief period in a recovery area until they fully wake up from the sedation. It’s essential to arrange for a friend or family member to drive them home, as the sedatives can impair driving ability.

Patients may experience mild discomfort, bloating, or a sore throat for a day or two after the procedure, but these symptoms generally resolve on their own. If any complications or severe symptoms arise, such as persistent abdominal pain, fever, chills, or heavy bleeding, patients should contact their healthcare provider immediately.

Conclusion: The Power of ERCP in Gastroenterology

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a powerful tool in the field of gastroenterology, offering both diagnostic and therapeutic capabilities.

By combining endoscopy and fluoroscopy, this procedure allows healthcare professionals to explore and treat conditions affecting the bile ducts, pancreas, and gallbladder with minimal invasiveness.

While ERCP can carry some risks and potential complications, it has greatly improved the accuracy of diagnoses and the effectiveness of treatments for a wide range of gastrointestinal conditions.

When performed by skilled and experienced gastroenterologists, ERCP can be a life-changing procedure that provides relief and improved quality of life for patients.

ercp_risks_benefits_infographic

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.

DISCLAIMER: PLEASE READ CAREFULLY

The information on this website is to provide general guidance. In no way does any of the information provided reflect definitive medical advice and self-diagnoses should not be made based on information obtained online. It is important to consult a Gastroenterologist or medical doctor regarding ANY and ALL symptoms or signs including, but not limited to: abdominal pain, haemorrhoids or anal / rectal bleeding as it may a sign of a serious illness or condition. A thorough consultation and examination should ALWAYS be performed for an accurate diagnosis and treatment plan. Be sure to call a physician or call our office today and schedule a consultation.

GIDoc Cape Town

Patient-focused GI treatments and procedures in Cape Town.

Monday-Friday 8AM-4PM.

Connect with Us

© Dr. Eduan Deetlefs, Registered Gastroenterologist, GI Doc Cape Town

Our website information is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a doctor about your specific condition. Only a trained physician can determine an accurate diagnosis and proper treatment.

Unraveling the Mystery of Crohn’s Disease: Causes, Symptoms, and Insights

Unraveling the Mystery of Crohn’s Disease: Causes, Symptoms, and Insights

Gain a better understanding of Crohn’s disease, a chronic inflammatory bowel condition that can affect various parts of the digestive tract.

Delve into the potential causes, common symptoms, and the diagnostic process to understand this complex autoimmune disorder better.

What is Crohn’s Disease?

Crohn’s disease is a chronic inflammatory bowel disease (IBD) that affects the lining of the digestive tract, also known as the gastrointestinal (GI) tract.

It can involve any part of the GI tract from the mouth to the anus, but it most commonly affects the end of the small intestine (ileum) and the beginning of the large intestine (colon).

The inflammation caused by Crohn’s disease can penetrate deep into the layers of the affected bowel tissue, leading to pain, discomfort, and various digestive symptoms.

The inflammation can also cause complications such as strictures (narrowing of the intestine), fistulas (abnormal connections between different parts of the intestine or between the intestine and other organs), and abscesses (pockets of infection).

Causes and Risk Factors

The exact cause of Crohn’s disease is still not completely understood, but it is believed to result from a complex interplay of genetic, environmental, and immune system factors.

Here are some of the known causes and risk factors associated with Crohn’s disease:

Genetics:
There is a clear genetic component to Crohn’s disease, as individuals with a family history of the condition are more likely to develop it. Several genes have been identified that may increase the risk of developing Crohn’s disease, but not everyone who carries these genes will develop the condition.
 

Immune system:
Crohn’s disease is considered an autoimmune disorder, in which the immune system mistakenly attacks healthy cells in the gastrointestinal tract. This immune response leads to chronic inflammation and tissue damage. The exact reason for this abnormal immune response is not fully understood, but it is believed to involve a combination of genetic and environmental factors.

Environmental factors:
Although the exact environmental triggers of Crohn’s disease are not known, several factors have been associated with an increased risk of developing the condition. These factors include smoking and having a diet high in fat and low in fiber. It has also been suggested that infections, particularly those involving the gastrointestinal tract, may play a role in triggering Crohn’s disease in susceptible individuals.

Age:
Crohn’s disease can occur at any age, but it is most commonly diagnosed in young adults between the ages of 15 and 35. However, it is important to note that the condition can develop later in life as well.

Smoking:
Smoking is a significant risk factor for the development of Crohn’s disease and is also associated with more severe disease and a higher risk of complications. Quitting smoking can help reduce the risk of developing the condition and improve the overall health of those who already have it.

crohns_symptoms

Common Symptoms of Crohn’s

The symptoms of Crohn’s disease can vary widely depending on the severity of inflammation and the specific parts of the digestive tract affected. Some common symptoms associated with Crohn’s disease include:

Abdominal Pain and Cramping:
This is often experienced in the lower right part of the abdomen but can occur anywhere along the digestive tract. The pain may be mild to severe and can come and go, often worsening after meals.

Diarrhea:
Frequent loose and watery stools are a common symptom of Crohn’s disease. In some cases, diarrhea may be severe and accompanied by blood or mucus.

Fatigue:
People with Crohn’s disease often experience a general feeling of tiredness and low energy levels due to inflammation, malabsorption of nutrients, and the impact of other symptoms on daily life.

Weight loss:
Unintentional weight loss can result from a combination of reduced appetite, malabsorption of nutrients, and increased calorie expenditure due to the ongoing inflammation in the digestive tract.

Fever:
A low-grade fever can sometimes accompany active inflammation in Crohn’s disease, particularly during flare-ups.

Mouth sores:
Painful sores, or ulcers, can develop in the mouth as a result of inflammation in the digestive tract.

Perianal disease:
This includes symptoms like pain, swelling, or drainage around the anus, which can result from the formation of abscesses, fissures, or fistulas.

Nutritional deficiencies:
Crohn’s disease can cause malabsorption of nutrients, leading to deficiencies in essential vitamins and minerals such as iron, vitamin B12, and vitamin D.

Joint pain:
Arthritis or joint pain can occur in some individuals with Crohn’s disease, affecting the knees, ankles, wrists, or other joints.

Skin issues:
Some people with Crohn’s disease may develop skin problems, such as erythema nodosum (painful red nodules under the skin) or pyoderma gangrenosum (painful ulcers that develop rapidly).


Eye inflammation:
Inflammation of the eyes, such as uveitis or episcleritis, can also be a symptom of Crohn’s disease.

crohns_diagnosis_and_testing

 

Diagnosis and Testing

Diagnosing Crohn’s disease can be challenging due to its varied symptoms and the fact that it can mimic other gastrointestinal conditions.

A combination of medical history, physical examination, and various tests and procedures is often required to accurately diagnose Crohn’s disease.

Here are some of the common steps and tests involved in diagnosing the condition:

Medical History and Physical Examination:
The physician will begin by taking a detailed medical history, including information about symptoms, family history of Crohn’s disease or other gastrointestinal disorders, and any medications the patient is taking. A physical examination will follow, focusing on signs of inflammation, malnutrition, or complications related to Crohn’s disease.

Blood Tests:
Blood tests can help identify signs of inflammation, anemia, and possible nutritional deficiencies. Common blood tests include complete blood count (CBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR).

Stool Tests:
Stool samples may be analyzed to rule out other causes of gastrointestinal symptoms, such as infections or parasites. The presence of fecal calprotectin, a protein that indicates inflammation in the intestines, can also be detected in stool samples and may be a marker for Crohn’s disease.

Imaging Studies:
Various imaging tests can help visualize the gastrointestinal tract and identify areas of inflammation, strictures, or other abnormalities. These tests may include X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), or ultrasound.
 

Endoscopy:
Endoscopic procedures involve inserting a flexible tube with a camera at its tip into the gastrointestinal tract to directly visualize the lining of the digestive tract and take biopsies (tissue samples) for further analysis. Two common endoscopic procedures used in diagnosing Crohn’s disease are:

Colonoscopy:
This procedure allows the physician to examine the entire colon and the end of the small intestine (ileum). Biopsies can be taken during a colonoscopy to help confirm the diagnosis.

upper_endoscopy_procedure

Upper endoscopy:
This procedure is used to examine the esophagus, stomach, and the first part of the small intestine (duodenum). It may be performed if symptoms suggest Crohn’s disease is affecting the upper gastrointestinal tract.

Capsule endoscopy:
In some cases, a capsule endoscopy may be recommended to visualize the small intestine, which can be difficult to examine using conventional endoscopy. The patient swallows a small capsule containing a camera, which takes pictures of the digestive tract as it passes through, transmitting the images to a recording device worn by the patient.

mystery_of_crohns_infographic

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. 

DISCLAIMER: PLEASE READ CAREFULLY

The information on this website is to provide general guidance. In no way does any of the information provided reflect definitive medical advice and self-diagnoses should not be made based on information obtained online. It is important to consult a Gastroenterologist or medical doctor regarding ANY and ALL symptoms or signs including, but not limited to: abdominal pain, haemorrhoids or anal / rectal bleeding as it may a sign of a serious illness or condition. A thorough consultation and examination should ALWAYS be performed for an accurate diagnosis and treatment plan. Be sure to call a physician or call our office today and schedule a consultation.

GIDoc Cape Town

Patient-focused GI treatments and procedures in Cape Town.

Monday-Friday 8AM-4PM.

Connect with Us

© Dr. Eduan Deetlefs, Registered Gastroenterologist, GI Doc Cape Town

Our website information is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a doctor about your specific condition. Only a trained physician can determine an accurate diagnosis and proper treatment.

Double-Balloon Enteroscopy Explained

Double-Balloon Enteroscopy Explained

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.

double_balloon_enetroscopy_procedure


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.

abdominal_pain_enteroscopy


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.

balloon_enteroscopy_recovery


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. 

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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.

DISCLAIMER: PLEASE READ CAREFULLY

The information on this website is to provide general guidance. In no way does any of the information provided reflect definitive medical advice and self-diagnoses should not be made based on information obtained online. It is important to consult a Gastroenterologist or medical doctor regarding ANY and ALL symptoms or signs including, but not limited to: abdominal pain, haemorrhoids or anal / rectal bleeding as it may a sign of a serious illness or condition. A thorough consultation and examination should ALWAYS be performed for an accurate diagnosis and treatment plan. Be sure to call a physician or call our office today and schedule a consultation.

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© Dr. Eduan Deetlefs, Registered Gastroenterologist, GI Doc Cape Town

Our website information is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a doctor about your specific condition. Only a trained physician can determine an accurate diagnosis and proper treatment.