Double-Balloon Enteroscopy Explained

                                                   What is Double-Balloon Enteroscopy?

 

Double-balloon Enteroscopy is a technique used by Gastroenterologists to gain visual access to the small bowel. 

The enteroscopy allows the doctor to have a complete internal view of the small intestine and the colon using two inflatable balloons. 

Your small bowel, which is the longest part of the intestine, is about six meters long and allows you to digest and absorb food before it gets into your colon, where the undigested food is then stored and eliminated.  

When a blockage causes the small intestine to swell, it is called a gastrointestinal obstruction, also known as a “blockage” or “obstruction.” 

Unlike single-balloon enteroscopy, a double-balloon technique is used when a patient has small bowel strictures (narrowing of the small bowel).

With the introducer device, the patient can be sedated so the procedure can be done on an outpatient basis instead of an operating room setting.

 

What Does DBE Involve? 

 

The double-balloon endoscope is inserted into the mouth and fed through the small intestines, doing a standard endoscopy of the small bowel. 

At one point during the procedure, the doctor inserts a small camera with an LED light to illuminate the small intestine. The double-balloon endoscope has two balloons — a water balloon and a gas balloon. 

The water balloon holds the endoscope in place to help the doctor view the small bowel. The gas balloon inflates later in the procedure and gives the doctor a better view.

These balloons are inflated prior to the procedure to enlarge the small intestine, so that the inner lining and tumors can be visualized.  

Most patients require sedative or general anesthesia to keep them still.
Some patients are given general anesthesia prior to the procedure, rather than local anesthesia, so they don’t require sedation or a general anesthetic. 

Also, this procedure does have a recovery time, so it is important to have time set aside immediately after the procedure.

 

 

Why a Double-Balloon Enteroscopy is Performed? 
 

There are many different reasons as to why a Double Balloon Enteroscopy is performed.

It can be very useful if the patient is experiencing severe constipation, bloating and/or vomiting.

The procedure is minimally invasive and as for recovery, patients can go back to playing their regular sport or exercise routines within a few days. 

This procedure is both diagnostic and interventional for a variety of small intestinal diseases such as: 

• Vascular Lesions
• Obtaining a biopsy of Tumors
• Placement of a Stent
• Removal of Polyps
• Dilating of a Stricture
• Involvement of inflammatory bowel diseases
• Diagnosis and treatment of mid-gastrointestinal bleeding 

 

What to Expect During the Procedure? 

  

 Many patients are worried about how they’ll feel during the Double-Balloon Enteroscopy procedure. 

There is a good chance they will feel nothing at all. 

You have two small balloons that are inflated in your small intestine.  These balloons are inflated prior to the procedure to enlarge the small intestine, so that the inner lining and tumors can be visualized. 

Your small intestine produces gas that can cause gas pains and cramping. When the balloons are inflated, the gas leaves your stomach and colon through the small intestine. 

The entire procedure takes about 10 to 15 minutes. 

 

How to Prepare for a DBE?

 

Before the Procedure

Your doctor’s office will instruct about preparation prior your procedure.
Confirm with your doctor on any medications you should stop for a time, including over-the-counter medication.

Diet

Your stomach and bowel should be empty during the procedure to make it possible to visualise the entire area. 
This decreases the possibility of food or fluid being vomited into the lungs while under sedation.

It is often a daunting task. Even though it is an outpatient procedure you will still need to plan time for rest following this procedure.  When you have to undergo a Double-balloon Enteroscopy, there are a few things you need to remember.

Should the procedure be done through the mouth, you should not eat or drink anything after midnight prior to the procedure. 

If your procedure will be done through the rectum, bowel prep will need to be done prior to your DBE.  This is similar to preparing for a colonoscopy.

Bowel prep is a necessary procedure when getting any invasive medical procedure done.

The primary side effect of bowel prep is diarrhea. However, this is only temporary and is recovered within six hours. 

 

The Risks

  

Like many medical devices, the double-balloon enteroscope comes with a list of risks.

The biggest downside of double-balloon enteroscopy is that in certain rare instances of double-balloon enteroscopy the patient runs the risk of leaking feces into the peritoneal cavity.

There is also a chance of the procedure leading to temporary nausea and vomiting.

Therefore, double-balloon enteroscopy is not recommended for use in individuals who are critically ill or those with other health complications.

For example, a patient who is older than 65 and has chronic pulmonary disease is at a higher risk for complications from the test.

If this patient has an incisional hernia or gastric bypass surgery, the complications are elevated further. 

Similar risks involved with having a colonoscopy done, can be expected with having a DBE done.

These risks include:

• Bleeding
• Perforation
• Complications of sedation

Side Effects of DBE?
 

Let’s discuss side effects. 

The unique feature of double-balloon enteroscopy is the fact that it allows you to conduct the procedure from the Oesophagus. 

This offers a number of benefits, like a reduced risk of post-procedure bleeding.
However, it also causes a few side effects like sores in the oesophagus after the procedure.

 Common Side Effects may include:

• Sore throat
• Nausea or vomiting
• Excessive gas, bloating or cramping
• Irregular heartbeat
• Headache
• Mild abdominal discomfort
• Minor bowel irritation
• Drowsiness

Your doctor will always outline exactly what you can expect after any medical procedure.   

 

What is the Recovery Time? 

 

Double-balloon enteroscopy is rapidly becoming one of the most effective and efficient ways to study the intestines.  

This procedure is a great method to use in conjunction with other procedures and the overall recovery time following a DBBE is usually around the same as for a standard colonoscopy.  

During the procedure itself there is usually little to no pain involved, however it is not uncommon for patients to suffer from some discomfort during double balloon enteroscopy.  

Other than this there may be other side effects such as temporary irregular heartbeat.  

However, these side effects are extremely uncommon and unlikely. 

You should be able to walk and talk right after and no more than 24–48 hours after the procedure is completed you should be fully active and back on your feet.  

Generally speaking, it is best to follow your doctor’s orders post-wand removal.  

 

 

 

GI Doc Cape Town is a practice founded to provide medical solutions in the area of gastroenterology. 

Over the years, Dr. Eduan 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. 

Should you experience any of the above symptoms or need any additional information regarding the above procedure, give us a call at 021 551 8678.