The endoscopic revolution

Written by: Dr Edward John Despott
Published: | Updated: 18/09/2023
Edited by: Cal Murphy

The small bowel is an 8 m long, floppy tube, which makes managing problems challenging. However, new endoscopic techniques are changing this. Top gastroenterologist Dr Edward John Despott, a specialist in double balloon enteroscopy, is here to explain:

What are endoscopic procedures?

Endoscopy is a technique used by doctors to examine the inside of the body, particularly the digestive system. A long, thin tube called an endoscope, with a camera and a light source attached, is passed into the patient’s body via the mouth, the anus, or through an incision made by the surgeon, depending on the part of the digestive tract that needs to be examined. Endoscopes may be used simply to view the patient’s digestive tract, or to take biopsies or even perform minimally invasive procedures using attachments on the endoscope.


New endoscopic options

Until recently, the only endoscopic options available for small bowel disease included the intrinsically limited ‘push’ enteroscopy, which only allows examination of the first metre of the bowel, and the significantly invasive intra-operative enteroscopy (IOE), which carries the risks of major surgery. In recent years, the development of wireless small bowel capsule endoscopy (SBCE) and double-balloon enteroscopy (DBE) have revolutionised endoscopic investigation and management of small bowel disease by facilitating visualisation of the entire SB without the need for surgery.

These two procedures are complementary. SBCE has a diagnostic role, limited to capturing images. It is used as an image ‘scout’ to guide DBE, which in turn offers tissue biopsy as well as therapeutic options.


Double balloon enteroscopy

DBE overcomes the challenges of the small bowel’s anatomy by employing a 200cm long enteroscope, 2 balloons and a 145 cm stabilising plastic overtube. The balloons inflate and deflate in an alternating pattern, folding the intestine wall around the overtube in a ‘push-and-pull’ manoeuvre to allow the enteroscope to pass deep into the digestive tract. It can be inserted orally or rectally, facilitating complete enteroscopy. A minimally invasive alternative to IOE, it allows surgeons administer endotherapy, such as argon plasma coagulation (APC), clipping and injection therapy of vascular lesions, dilatation of strictures, polypectomy and direct percutaneous endoscopic jejunostomy (DPEJ) placement for enteral nutrition.


What are the risks of double balloon enteroscopy?

DBE is a safe and effective procedure (with overall complication rates of <1%); in appropriate cases, the endotherapy it offers has also been shown to avoid the need for operative surgery.

It is nonetheless a complex, advanced endoscopic procedure which requires years of dedicated training to be performed effectively and is only available in a handful of specialist centres in the UK and currently only three NHS centres and only one private centre in London (The Royal Free Private Patients Unit). The Royal Free DBE service is currently the most advanced and busiest DBE service in the UK with its lead clinicians (who underwent dedicated training in DBE in Japan) having over 11 years of experience in the performance of this complex procedure.


Visit Dr Edward John Despott’s Top Doctors profile to book an appointment with him today. 

By Dr Edward John Despott

Dr Edward John Despott is a consultant gastroenterologist and interventional endoscopist based in London, practicing privately at The Wellington Hospital and the Royal Free Hospital. He is the clinical lead of endoscopy services at the Royal Free Hospital's Unit for Endoscopy, where he also proudly works for the NHS. Alongside endoscopy (keyhole surgery), his specialisms include double-balloon enteroscopy, colonoscopy and gastroscopy. Furthermore, he has expertise in capsule endoscopy and polyps.

Dr Despott has significantly contributed to the Royal Free Unit for Endoscopy's renowned reputation of being one of the only few centres in London and the UK to offer a small bowel endoscopy service that offers top specialist facilities and treatments.      

Dr Despott´s expertise, which also lies in therapeutic colonoscopy, transnasal upper GI endoscopy, inflammatory bowel disease and its' related complications, is also reflected in his clinical academic work as Honorary Associate professor at University College London's Institute of Liver and Digestive Health. He leads his students in the essential areas of endoscopy service delivery, education and training.

Dr Despott is highly qualified, reflecting his impressive reputation as a top specialist. He graduated from the University of Malta in 1999, completed his general professional training there and then moved to the UK to pursue higher specialist training in gastroenterology and general (internal) medicine within the North East Thames rotation of the London Deanery School of Medicine. He also underwent advanced endoscopy training at the Wolfson Unit for Endoscopy at St Mark’s Hospital and Academic Institute and did formal research at Imperial College London, achieving a further doctorate in medical research -MD(Res), a PhD equivalent.

Dr Despott is an active member of groups including the British Society of Gastroenterology (BSG), the European Society of Gastroinestinal Endoscopy (ESGE), where he is on the guidelines committee for small bowel endoscopy, and the American Society of Gastrointestinal Endoscopy (ASGE). He is the senior associate editor of VideoGIE, an official journal of ASGE. He has national and international experience in lecturing, training courses and holding masterclasses, performing live endoscopy demonstrations and travelling fellowships in Japan for the Japanese GI Endoscopy Society (JGES) and BSG. 

Dr Despott's research has been widely published in various scientific peer-reviewed papers, book chapters and review articles. He regularly acts as a referee for widely respected journals. He is also a fellow of the European Board of Gastroenterology and Hepatology (FEBGH), the ASGE (FASGE) and the Royal College of Physicians (FRCP), London.

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