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.

 

 

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.