DOUBLE BALLOON ENTEROSCOPY OVERVIEW

A double balloon enteroscopy, often referred to as a DBE is a procedure that allows a doctor to directly examine the small bowel.

The doctor who performs the procedure, has special training in using a specially designed endoscope with two balloons, hence the name double balloon, that allows him to examine the small bowel.

 

REASONS FOR A DOUBLE BALLOON ENTEROSCOPY

The most common reasons to do a DBE include:

• To look for a source of bleeding from the small bowel
• To obtain biopsies (samples) from the lining of the small bowel to send for further (histologic) examination
• Removal of polyps from the small bowel
• Treating a narrowing (stricture) in the small bowel

The most common reason to have a DBE is to look for a source of bleeding from the small bowel.

In this case you would probably have had a gastroscopy to examine the top part of the intestinal tract (food pipe or oesophagus, stomach and first part of the small bowel called the duodenum) and a colonoscopy to examine the large bowel or colon.

Both of these examinations were either normal or did no explain your symptoms and your doctor had reason to believe that the problem is in the small bowel. You might have had a capsule endoscopy to examine the small bowel.

If the capsule endoscopy was normal the DBE is done to make sure nothing was missed and if the capsule endoscopy showed an abnormality the DBE is done to identify the abnormality and possibly to treat it through the scope.

The most common causes of bleeding from the small bowel can be grouped as follows:

• Bleeding blood vessels- the most common type is called angio-ectasia
• Ulcers – there are many causes of small bowel ulcers but the most common is anti-inflammatory pain medication
• Tumours or growths which could be either cancerous or non-cancerous.

 

PREPARATION FOR DOUBLE BALLOON ENTEROSCOPY

 

Diet

Your stomach and small bowel should be empty during the procedure to make it possible to visualise the entire area and to decrease possibility of food or fluid being vomited into the lungs while under sedation (called aspiration).

You should be fasting for solids from 8 pm on the day before the procedure. You may drink clear fluids (no milk) up to 3 hours before your DBE on the day of the procedure.

 

Medicines

You can take most prescription and nonprescription medicines right up to the day of the gastroscopy.

Your doctor should tell you what medicines to stop. You should also tell the doctor if you are allergic to any medicines.

Some medicines increase the risk of heavy bleeding if you have a biopsy during the double balloon enteroscopy.

Ask your doctor how and when to stop these medicines, including Warfarin and Clopidogrel/Plavix®.

 

Diabetics

If you are a diabetic please DO NOT TAKE YOUR DIABETIC MEDICATION (either tablets or insulin) on the morning of your procedure day.

You will be fasting and taking your medication increases your risk of developing a low blood sugar reading (hypoglycaemia).

If you do develop a hypoglycaemia it is advisable to drink sugar water – this should not influence the doctor’s ability to perform your procedure.

 

Latex Allergy

A part of the scope that is used to perform the double balloon enteroscopy is made out of latex.
Please inform your doctor if you have a latex allergy as it might not be able to do the procedure safely if this is the case. 

Transportation Home

You should arrange for a friend or family member to escort you home after the examination.

Although you will be awake by the time you are discharged, the medications used for sedation cause temporary changes in the reflexes and judgment and interfere with your ability to drive or make decisions (similar to the effects of alcohol).

 

THE DOUBLE BALLOON ENTEROSCOPY PROCEDURE

Before the test, a doctor will review the test, including possible complications, and you will be asked to sign a consent form.

The nurse or doctor will start an IV line in your hand or arm. Your blood pressure, heart rate and oxygen levels will be monitored during the test.

The monitoring is not painful. For safety reasons, dentures should be removed before the procedure. The procedure typically takes between 90 and 120 minutes to complete.

The endoscopy is performed while you lie on your left side. Sometimes the doctor will give a medication to numb the throat (either a gargle or a spray).

A plastic mouth guard is placed between the teeth to prevent damage to the teeth and scope.

The double balloon scope is a flexible tube, approximately the thickness of the index finger.

The scope has a lens and a light source that allows the doctor to see the inner lining of the upper gastrointestinal tract by viewing it on a TV monitor.

The double balloon scope is an advanced piece of equipment that allows a doctor to examine parts of the intestine that could not previously be examined.

It consists of two balloons that are inflated in a sequential manner to pull the bowel over the scope and in that way make it possible to advance the scope deep into the small bowel.

Most people have no difficulty swallowing the flexible scope as a result of the sedating medications.

The test will be done under conscious sedation with the assistance of an anaesthetist.

Many people sleep during the test, others are very relaxed and generally not aware of the examination.

The doctor may take tissue samples called biopsies (not painful), or perform specific treatments (such as dilation, removal of polyps, treatment of bleeding), depending upon what is found during the examination.

Air is introduced through the scope to open the esophagus, stomach, and intestine, allowing the scope to be passed through these structures and improving the doctor’s ability to see all of the structures.

You may experience a mild discomfort as air is pushed into the intestinal tract. This is not harmful and belching may relieve the sensation.

The endoscope does not interfere with breathing. Taking slow, deep breaths during the procedure may help you to relax.

 

DOUBLE BALLOON ENTEROSCOPY RECOVERY

After the DBE you will be observed for one to two hours while the sedative medication wears off.

The medicines cause most people to temporarily feel tired or have difficulty concentrating and you should not drive or return to work after the procedure.

The most common discomfort after the examination is a feeling of bloating as a result of the air introduced during the examination.

This usually resolves quickly. Some patients also have a mild sore throat. Most patients are able to eat shortly after the examination.

 

DOUBLE BALLOON ENTEROSCOPY COMPLICATIONS

Double balloon enteroscopy is a safe procedure and complications are uncommon. The following is a list of possible complications:

• Aspiration (inhaling) of food or fluids into the lungs, the risk of which can be minimised by not eating or drinking for the recommended period of time before the examination
• The endoscope can cause a tear or hole in the tissue being examined. This is a serious complication but fortunately occurs only rarely
• Bleeding can occur from biopsies or the removal of polyps, although it is usually minimal and stops quickly on its own or can be easily controlled
• As the small bowel lies close to the pancreas, the pancreas can be become inflamed and pancreatitis can develop. This is a rare complication and in most instances causes a mild abdominal discomfort. It can however be serious needing hospitalisation.
• Reactions to the sedative medications are possible; the endoscopy team (doctors and nurses) will ask about previous medication allergies or reactions and about health problems such as heart, lung, kidney, or liver disease. Providing this information to the team ensures a safer examination.
• The medications may produce irritation in the vein at the site of the intravenous line. If redness, swelling, or discomfort occurs, you should call your doctor.

The following signs and symptoms should be reported immediately:

• Severe abdominal pain (more than gas cramps)
• A firm, distended abdomen
• Vomiting
• Any temperature elevation
• Difficulty swallowing or severe throat pain
• A crunching feeling under the skin of the neck.

 

AFTER THE DOUBLE BALLOON ENTEROSCOPY

Most patients tolerate endoscopy very well and feel fine afterwards. Some fatigue is common after the examination, and you should plan to take it easy and relax the rest of the day.

The doctor can describe the result of the examination before you leave the hospital.

If biopsies have been taken or polyps removed your doctor will discuss further follow-up arrangements with you.

Adapted from www.uptodate.com