Double balloon enteroscopy explained: part 2

In the second article of a two-part series, distinguished consultant gastroenterologist Dr Edward John Despott discusses what a double balloon enteroscopy can detect in the bowel, and why someone may consider undergoing the procedure.

What does double balloon enteroscopy detect in the bowel?

As mentioned in part 1, double balloon enteroscopy can be used for bleeding lesions in patients who have been suffering from what we call angioectasias, or small intestinal vascular lesions. It allows us to apply clips or even cauterise these. It allows us to take biopsies, for example, if we're suspicious of inflammation or we suspect that there is malignancy.

Additionally, the procedure permits us to mark areas for laparoscopic (minimally invasive) keyhole surgical removal of a tumour, for example. This can avoid the creation of a large cut. In addition, it also allows us to treat certain conditions such as narrowing of the small bowel, stricturing disease, for example, in Crohn's or in non-steroidal enteropathy.

Double balloon enteroscopy also allows us to remove certain types of polyps, particularly in the context of Peutz-Jeghers Syndrome a polyposis syndrome that creates polyps in the small bowel. Finally, with the procedure, we can even investigate areas of abnormality that have been picked up on a CT scan, for example, a CT enterography or on capsule endoscopy.

The procedure really allows us to have a detailed look at the small bowel, not only to look at, but also to take biopsies and treat; that is the main difference between capsule endoscopy and double balloon endoscopy. However, of course, we always do things like capsules. This is indicated beforehand, and if we can't do a capsule or if we want to do another test, we also can recourse to a CT scan, a CT enterography or an MRI scan, often before the double balloon endoscopy because that serves to guide us to the abnormality line

Is this safe? How painful can it be?

Double balloon enteroscopy is an extremely safe procedure. My centre consists of the most experienced surgeons in the procedure, after Japan. The centre has been running for over 12 years. We are considered to be the busiest centre in Europe and the second busiest centre in the world. We do up to eight weekly double balloon endoscopies.

Complication rates associated with double balloon enteroscopy are less than 1 per cent overall. As with any other endoscopic procedure, there are small risks like any other endoscopic procedure such as a tear in the bowel which can cause bleeding or infection, but this is extremely unlikely.

In rare circumstances, it can irritate the pancreas. That being said, with our experience, even with therapy, the complication rates are exceedingly low.

Double balloon enterescopy is not really a painful procedure, but it can be slightly uncomfortable. As a result, we perform the procedure while the patient is under deep sedation with propofol, in the presence of an anaesthetist, or else if necessary, with general anaesthetic. However, anaesthetists are often able to provide the patient with the vast majority of occasions are able to provide the right degree of comfort and safety for our patients.

Why might someone require a double balloon enteroscopy?

A double balloon enteroscopy is usually required when someone presents with small bowel disease, for example, small bowel bleeding, or, the context of Crohn's disease, when there are areas of inflammation, which we're not sure about when we need tissue sampling.

It can also be utilised for taking biopsies, treating the narrowings of the small bowels, such as strictures in the context of Crohn's disease or non-steroidal enteropathy, a condition caused by the intake of non-steroidal anti-inflammatory drugs over a long period of time.

Furthermore, a double balloon enteroscopy allows us to remove polyps from the small bowel and it allows us to also inspect certain areas of suspicion, which for example, have been seen on a CT scan. It can provide the whole remit, both diagnostics and therapeutics of the small bowel, which previously was a very challenging place to look into.

A double balloon endoscopy usually takes between half an hour and up to two hours, but often it just takes about an hour or so depending on what we need to do and where we need to go. Each case is judged by its own merits and takes as long as it should, but usually, it covers between 30 minutes to an hour. However, it can take up to two hours.

If you would like to book an appointment with Dr Despott, do not hesitate to do so by visiting his Top Doctors profile today.