Balloon enteroscopy: everything you need to know

Highly experienced consultant physician and gastroenterologist Dr Laurence Maiden explains all there is to know about a balloon enteroscopy, including how it differs from a traditional endoscopy.

What exactly is a balloon enteroscopy?

Enteroscopy means endoscopy of the small bowel. Traditional endoscopy or gastroscopy is looking at the stomach, the food pipe of the stomach and the first part of the small intestine and the camera doesn’t go in very far. However, to try and have a look in the small bowel requires a longer telescope because the small bowel is much longer and varies from person to person. It’s quite difficult to get to and for a long time it’s been very challenging to introduce a telescope down into the small bowel.

Around about 10 years ago, an instrument was developed which includes an enteroscope (a longer telescope) with an overtube as a balloon, that can be inflated and deflated. When that’s introduced from the mouth down the food pipe and into the bowel, the balloon can be inflated and holds onto the small bowel, meaning that the telescope, or the enteroscope can then be pushed further down into the bowel.

That overtube and the balloon are then deflated but with the tube pushed down further and the balloon reinflated, and then everything is pulled back. This is so that you can then get the telescope even further down and repeat that process by deflating the balloon and re-inflating it when you push the tube further down into the bowel. This reinflates everything, pulling it back a bit futher and then you can introduce the telescope even further down into the small bowel.

It is an invasive technique which can be used in order to put the camera further down into the gastrointestinal tract than we’ve been able to historically. It’s often done under sedation with analgesia because it’s a slightly longer procedure and can be a little more invasive than a traditional endoscopy or gastroscopy. 

What exactly does it treat?

A balloon enteroscopy is designed to look at the small intestine. The enteroscope is introduced further than a gastroscope into the small intestines, which allows the endoscopist to look further into the small bowel than is traditionally possible with the older telescopes.

An enteroscope or a balloon enteroscope is designed to treat any disease process occurring in the small intestines, so not only to diagnose but sometimes to take biopsies or tissue samples of the bowel wall, looking for inflammation. It looks for inflammation from, for example, crohn’s disease or biopsies (if you’re suspecting celiac disease) or other pathology.

However, you can also apply therapeutic measures; you can actually try and do something to alleviate symptoms if there’s bleeding from a blood vessel and the endoscopist may be able to clip or inject or spray a bleeding blood vessel.

Why should patients opt for a balloon enteroscopy?

Patients may be put forward for a balloon enteroscopy if disease has been suspected in the small bowel or perhaps it has been demonstrated in other investigations.

Patients may have had a capsule endoscopy to look at the small bowel which may have been highlighted a finding or potential disease or they may have had a CT scan or an MRI.  Additionally, there may be a family history of certain disorders or diseases such as irritable bowel syndrome (IBS) which may alert the doctor or physician that there may be a disease further down in the small bowel.

If biopsies or tissue samples are needed, if there’s bleeding which needs to be stopped or if there’s a polyp that needs to be retrieved, a patient may undergo a balloon enteroscopy in order to have a therapeutic procedure undertaken once they have had a diagnostic investigation beforehand such as imaging or a capsule endoscopy.  

If there’s a fleshy lump or a polyp, we’re able to remove the polyp endoscopically. We can retrieve the polyp and then analyse it.

It is designed to treat specifically small bowel disease, when pathology or disease is being suspected or demonstrated in that particular part of the gastrointenstinal tract.

When would it be necessary?

Necessity for a balloon enteroscopy depends on what you’re trying to achieve. It can be a more invasive procedure, take a little longer and be a little bit more uncomfortable than a traditional endoscopy or gastroscopy, therefore surgeons normally only want to undertake the procedure if there is a need to take tissue samples or do something therapeutic such as stop bleeding or remove a polyp.

It wouldn’t be used in the first instance as a diagnostic tool because it’s quite an invasive test. I think we’d look at capsule endoscopy or an MRI of the small bowel or some other means of investigation first, to try and diagnose a problem that then needs therapeutic intervention.

It’s incredibly effective if you require biopsies, in removing polyps and if you need to stop bleeding in the bowel. It’s a very effective means to be able to undertake a therapeutic procedure, if that’s what’s required.

How safe is it, and how long does it take?

As with all invasive procedures, there’s a risk of untoward events such as bleeding or causing a tear in the bowel but these are incredibly rare procedures, meaning that it certainly is a safe procedure to undertake.   

If you require a balloon enteroscopy amd would like to book a consultation with Dr Maiden, do not hesitate to do so via his Top Doctors profile today.