Double-Balloon Enteroscopy

Double-balloon enteroscopy is an interesting and modern endoscopic method aimed to examine the small intestine.


Small intestine is a poorly examinable gastrointestinal organ. Conventional endoscopic methods are great in examination of esophagus, stomach an duodenum (upper GI endoscopy) and colon (colonoscopy).


Double-balloon enteroscopy is  performed by a classic flexible endoscopic device, which is covered by a special tube. Both the endoscope and the tube have an inflatable balloon at their ends. By alternately inflating and deflating the balloons, it is possible to gather the digestive tube on the device and this allows to get very deep into the small intestine. The examination allows the doctor to see the intestinal cavity, take samples for histological examination or even perform certain therapeutic interventions.


The preparation depends on the actual approach. When the tube is introduced through mouth, the preparation is similar to classic upper GI endoscopy, i.e. fasting for 6 hours before the procedure (no food or fluids). Less commonly, when we want to examine the lower part of the small intestine, the endoscopic device may be inserted into the small intestine through rectum and the whole large intestine. In such case, the patient's preparation is similar to classical colonoscopy.


Enteroscopy is usually performed in hospitalized patients. During the actual examination, the patient is placed on an examination table and sedated by intravenously administered medications. That means the patient is not sleeping, but usually one does not remember the examination at all.


As mentioned above, the balloon enteroscopy is suitable for examination of disease of small intestine. The inside of the small intestine is normally examinable only by the endoscopic capsule, which is not always reliable and in addition, the capsule may get stuck when there is present an intestinal stricture.


Double-balloon enteroscopy is preferably used in bleeding in the gastrointestinal tract when there is not found any source of hemorrhage in the esophagus, stomach, duodenum and colon. Any site of bleeding can be visualized by camera and adequately treated. When we find a tumor of the small intestine, it is possible to take samples for histological examination.


The examination carries all risks and possible complications of upper GI endoscopy or colonoscopy (depending on the endoscopic approach). The most serious complication is rupture of the intestine as the small intestine wall is quite weak. Acute pancreatitis has been reported more frequently in patients after the procedure, possibly due to indirect irritation of pancreas by the endoscope. The examination is quite time-consuming and may last for hours. In addition, it is less available. It is necessary to mention the lower availability of this examination.


Double-balloon enteroscopy is elegant, though less available method, which allows us to view the inside of the small intestine and directly treat various pathological findings (particularly sources of bleeding).


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources