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Double-balloon enteroscopy

April 16, 2024

Double-balloon enteroscopy, also known as push-and-pull enteroscopy, is an endoscopic technique for visualization of the small bowel. It was developed by Hironori Yamamoto in 2001.[1] It is novel in the field of diagnostic gastroenterology as it is the first endoscopic technique that allows for the entire gastrointestinal tract to be visualized in real time.[2]

Double-balloon enteroscopy
Endoscopic image of normal small bowel
MeSHD058582
[edit on Wikidata]

Technique edit

The technique involves the use of a balloon at the end of a special enteroscope camera and an overtube, which is a tube that fits over the endoscope, and which is also fitted with a balloon.[2] The procedure is usually done under general anesthesia, but may be done with the use of conscious sedation.[3] The enteroscope and overtube are inserted through the mouth and passed in conventional fashion (that is, as with gastroscopy) into the small bowel.[1]

Following this, the endoscope is advanced a small distance in front of the overtube and the balloon at the end is inflated. Using the assistance of friction at the interface of the enteroscope and intestinal wall, the small bowel is accordioned back to the overtube. The overtube balloon is then deployed, and the enteroscope balloon is deflated. The process is then continued until the entire small bowel is visualized.[4]

The double-balloon enteroscope can also be passed in retrograde fashion, through the colon and into the ileum to visualize the end of the small bowel.[1]

Indications edit

Double-balloon enteroscopy has found a niche application in the following settings:

Advantages edit

 
Endoscopic image of polyp in small bowel detected on double-balloon enteroscopy

Double-balloon enteroscopy offers a number of advantages to other small bowel image techniques, including barium imaging, wireless capsule endoscopy and push enteroscopy:

  • It allows for visualization of the entire small bowel to the terminal ileum.[1]
  • It allows for the application of therapeutics.[9]
  • It allows for the sampling or biopsying of small bowel mucosa, for the resection of polyps of the small bowel,[10] and in the placement of stents or dilatation of strictures of the small bowel.[7]
  • It allows for access to the papilla in patients with long afferent limbs after Billroth II antrectomy.

Disadvantages edit

The key disadvantage of double-balloon enteroscopy is the time required to visualize the small bowel; this can exceed three hours, and may require that patients be admitted to hospital for the procedure.[11] There have also been case reports of acute pancreatitis (at a rate of 0.3%–0.4%, when the oral route is used)[12][13] and intestinal necrosis[14] associated with the technique.

A 2015 study in the World Journal of Gastrointestinal Endoscopy reported that: "Due to prolonged procedure and air insufflation, abdominal pain can be observed in up to 20% patients."[12] Depending on whether the oral or rectal approach was used, a patient may experience a sore throat (following use of the oral route), upset stomach, vomiting, and painful bloating, cramping, or abdominal discomfort in reaction to the gas in the intestines.[15][16]

References edit

  1. ^ a b c d Yamamoto, H; Sekine, Y; Sato, Y; Higashizawa, T; Miyata, T; Iino, S; Ido, K; Sugano, K (2001). "Total enteroscopy with a nonsurgical steerable double-balloon method". Gastrointestinal Endoscopy. 53 (2): 216–20. doi:10.1067/mge.2001.112181. PMID 11174299.
  2. ^ a b Yamamoto, H; Sugano, K (2003). "A new method of enteroscopy--the double-balloon method". Canadian Journal of Gastroenterology. 17 (4): 273–4. doi:10.1155/2003/309532. PMID 12704472.
  3. ^ May, A; Nachbar, L; Wardak, A; Yamamoto, H; Ell, C (2003). "Double-balloon enteroscopy: preliminary experience in patients with obscure gastrointestinal bleeding or chronic abdominal pain". Endoscopy. 35 (12): 985–91. doi:10.1055/s-2003-44582. PMID 14648408. S2CID 36779881.
  4. ^ Yamamoto, H; Yano, T; Kita, H; Sunada, K; Ido, K; Sugano, K (2003). "New system of double-balloon enteroscopy for diagnosis and treatment of small intestinal disorders". Gastroenterology. 125 (5): 1556, author reply 1556–7. doi:10.1016/j.gastro.2003.03.004. PMID 14628813.
  5. ^ Yen, HH; Chen, YY; Soon, MS; Lin, YM (2007). "An unusual cause of obscure gastrointestinal bleeding". Gut. 56 (1): 12, 28. doi:10.1136/gut.2006.094631. PMC 1856651. PMID 16507584.
  6. ^ Chan, AO; Lai, KC (2006). "A patient with long-standing iron-deficient anemia". Nature Clinical Practice Gastroenterology & Hepatology. 3 (2): 112–6, quiz 117. doi:10.1038/ncpgasthep0413. PMID 16456577. S2CID 20780715.
  7. ^ a b Kita, H; Yamamoto, H (2006). "Double-balloon endoscopy for the diagnosis and treatment of small intestinal disease". Best Practice & Research. Clinical Gastroenterology. 20 (1): 179–94. doi:10.1016/j.bpg.2005.09.004. PMID 16473807.
  8. ^ Mönkemüller, K; Bellutti, M; Neumann, H; Malfertheiner, P (2008). "Therapeutic ERCP with the double-balloon enteroscope in patients with Roux-en-Y anastomosis". Gastrointestinal Endoscopy. 67 (6): 992–6. doi:10.1016/j.gie.2007.10.023. PMID 18279869.
  9. ^ Nishimura, M; Yamamoto, H; Kita, H; Yano, T; Sunada, K; Miyata, T; Sugimoto, T; Iino, S; et al. (2004). "Gastrointestinal stromal tumor in the jejunum: diagnosis and control of bleeding with electrocoagulation by using double-balloon enteroscopy". Journal of Gastroenterology. 39 (10): 1001–4. doi:10.1007/s00535-004-1434-6. PMID 15549455. S2CID 12752480.
  10. ^ Ohmiya, N; Taguchi, A; Shirai, K; Mabuchi, N; Arakawa, D; Kanazawa, H; Ozeki, M; Yamada, M; et al. (2005). "Endoscopic resection of Peutz-Jeghers polyps throughout the small intestine at double-balloon enteroscopy without laparotomy". Gastrointestinal Endoscopy. 61 (1): 140–7. doi:10.1016/S0016-5107(04)02457-5. PMID 15672077.
  11. ^ Lo, SK; Mehdizadeh, S (2006). "Therapeutic uses of double-balloon enteroscopy". Gastrointestinal Endoscopy Clinics of North America. 16 (2): 363–76. doi:10.1016/j.giec.2006.03.002. PMID 16644464.
  12. ^ a b Saygili, Fatih; Saygili, Saba Mukaddes; Oztas, Erkin (March 16, 2015). "Examining the whole bowel, double balloon enteroscopy: Indications, diagnostic yield and complications". World Journal of Gastrointestinal Endoscopy. 7 (3): 247–252. doi:10.4253/wjge.v7.i3.247. PMC 4360443. PMID 25789095.
  13. ^ Honda, K; Mizutani, T; Nakamura, K; Higuchi, N; Kanayama, K; Sumida, Y; Yoshinaga, S; Itaba, S; et al. (2006). "Acute pancreatitis associated with peroral double-balloon enteroscopy: a case report". World Journal of Gastroenterology. 12 (11): 1802–4. doi:10.3748/wjg.v12.i11.1802. PMC 4124365. PMID 16586559.
  14. ^ Yen, HH; Chen, YY; Su, WW; Soon, MS; Lin, YM (2006). "Intestinal necrosis as a complication of epinephrine injection therapy during double-balloon enteroscopy". Endoscopy. 38 (5): 542. doi:10.1055/s-2006-925184. PMID 16586243.
  15. ^ "Enteroscopy". www.hopkinsmedicine.org. November 14, 2022.
  16. ^ "Balloon-Assisted Enteroscopy: Definition, Process & Recovery". Cleveland Clinic.

April 16, 2024
double, balloon, enteroscopy, also, known, push, pull, enteroscopy, endoscopic, technique, visualization, small, bowel, developed, hironori, yamamoto, 2001, novel, field, diagnostic, gastroenterology, first, endoscopic, technique, that, allows, entire, gastroi. Double balloon enteroscopy also known as push and pull enteroscopy is an endoscopic technique for visualization of the small bowel It was developed by Hironori Yamamoto in 2001 1 It is novel in the field of diagnostic gastroenterology as it is the first endoscopic technique that allows for the entire gastrointestinal tract to be visualized in real time 2 Double balloon enteroscopyEndoscopic image of normal small bowelMeSHD058582 edit on Wikidata Contents 1 Technique 2 Indications 3 Advantages 4 Disadvantages 5 ReferencesTechnique editThe technique involves the use of a balloon at the end of a special enteroscope camera and an overtube which is a tube that fits over the endoscope and which is also fitted with a balloon 2 The procedure is usually done under general anesthesia but may be done with the use of conscious sedation 3 The enteroscope and overtube are inserted through the mouth and passed in conventional fashion that is as with gastroscopy into the small bowel 1 Following this the endoscope is advanced a small distance in front of the overtube and the balloon at the end is inflated Using the assistance of friction at the interface of the enteroscope and intestinal wall the small bowel is accordioned back to the overtube The overtube balloon is then deployed and the enteroscope balloon is deflated The process is then continued until the entire small bowel is visualized 4 The double balloon enteroscope can also be passed in retrograde fashion through the colon and into the ileum to visualize the end of the small bowel 1 Indications editDouble balloon enteroscopy has found a niche application in the following settings Bleeding from the gastrointestinal tract of obscure cause 5 Iron deficiency anemia with normal colonoscopy and gastroscopy 6 Visualization and therapeutic intervention on abnormalities seen on traditional small bowel imaging 7 Endoscopic retrograde cholangiopancreatography ERCP in post surgical patients with long afferent limbs 8 Advantages edit nbsp Endoscopic image of polyp in small bowel detected on double balloon enteroscopyDouble balloon enteroscopy offers a number of advantages to other small bowel image techniques including barium imaging wireless capsule endoscopy and push enteroscopy It allows for visualization of the entire small bowel to the terminal ileum 1 It allows for the application of therapeutics 9 It allows for the sampling or biopsying of small bowel mucosa for the resection of polyps of the small bowel 10 and in the placement of stents or dilatation of strictures of the small bowel 7 It allows for access to the papilla in patients with long afferent limbs after Billroth II antrectomy Disadvantages editThe key disadvantage of double balloon enteroscopy is the time required to visualize the small bowel this can exceed three hours and may require that patients be admitted to hospital for the procedure 11 There have also been case reports of acute pancreatitis at a rate of 0 3 0 4 when the oral route is used 12 13 and intestinal necrosis 14 associated with the technique A 2015 study in the World Journal of Gastrointestinal Endoscopy reported that Due to prolonged procedure and air insufflation abdominal pain can be observed in up to 20 patients 12 Depending on whether the oral or rectal approach was used a patient may experience a sore throat following use of the oral route upset stomach vomiting and painful bloating cramping or abdominal discomfort in reaction to the gas in the intestines 15 16 References edit a b c d Yamamoto H Sekine Y Sato Y Higashizawa T Miyata T Iino S Ido K Sugano K 2001 Total enteroscopy with a nonsurgical steerable double balloon method Gastrointestinal Endoscopy 53 2 216 20 doi 10 1067 mge 2001 112181 PMID 11174299 a b Yamamoto H Sugano K 2003 A new method of enteroscopy the double balloon method Canadian Journal of Gastroenterology 17 4 273 4 doi 10 1155 2003 309532 PMID 12704472 May A Nachbar L Wardak A Yamamoto H Ell C 2003 Double balloon enteroscopy preliminary experience in patients with obscure gastrointestinal bleeding or chronic abdominal pain Endoscopy 35 12 985 91 doi 10 1055 s 2003 44582 PMID 14648408 S2CID 36779881 Yamamoto H Yano T Kita H Sunada K Ido K Sugano K 2003 New system of double balloon enteroscopy for diagnosis and treatment of small intestinal disorders Gastroenterology 125 5 1556 author reply 1556 7 doi 10 1016 j gastro 2003 03 004 PMID 14628813 Yen HH Chen YY Soon MS Lin YM 2007 An unusual cause of obscure gastrointestinal bleeding Gut 56 1 12 28 doi 10 1136 gut 2006 094631 PMC 1856651 PMID 16507584 Chan AO Lai KC 2006 A patient with long standing iron deficient anemia Nature Clinical Practice Gastroenterology amp Hepatology 3 2 112 6 quiz 117 doi 10 1038 ncpgasthep0413 PMID 16456577 S2CID 20780715 a b Kita H Yamamoto H 2006 Double balloon endoscopy for the diagnosis and treatment of small intestinal disease Best Practice amp Research Clinical Gastroenterology 20 1 179 94 doi 10 1016 j bpg 2005 09 004 PMID 16473807 Monkemuller K Bellutti M Neumann H Malfertheiner P 2008 Therapeutic ERCP with the double balloon enteroscope in patients with Roux en Y anastomosis Gastrointestinal Endoscopy 67 6 992 6 doi 10 1016 j gie 2007 10 023 PMID 18279869 Nishimura M Yamamoto H Kita H Yano T Sunada K Miyata T Sugimoto T Iino S et al 2004 Gastrointestinal stromal tumor in the jejunum diagnosis and control of bleeding with electrocoagulation by using double balloon enteroscopy Journal of Gastroenterology 39 10 1001 4 doi 10 1007 s00535 004 1434 6 PMID 15549455 S2CID 12752480 Ohmiya N Taguchi A Shirai K Mabuchi N Arakawa D Kanazawa H Ozeki M Yamada M et al 2005 Endoscopic resection of Peutz Jeghers polyps throughout the small intestine at double balloon enteroscopy without laparotomy Gastrointestinal Endoscopy 61 1 140 7 doi 10 1016 S0016 5107 04 02457 5 PMID 15672077 Lo SK Mehdizadeh S 2006 Therapeutic uses of double balloon enteroscopy Gastrointestinal Endoscopy Clinics of North America 16 2 363 76 doi 10 1016 j giec 2006 03 002 PMID 16644464 a b Saygili Fatih Saygili Saba Mukaddes Oztas Erkin March 16 2015 Examining the whole bowel double balloon enteroscopy Indications diagnostic yield and complications World Journal of Gastrointestinal Endoscopy 7 3 247 252 doi 10 4253 wjge v7 i3 247 PMC 4360443 PMID 25789095 Honda K Mizutani T Nakamura K Higuchi N Kanayama K Sumida Y Yoshinaga S Itaba S et al 2006 Acute pancreatitis associated with peroral double balloon enteroscopy a case report World Journal of Gastroenterology 12 11 1802 4 doi 10 3748 wjg v12 i11 1802 PMC 4124365 PMID 16586559 Yen HH Chen YY Su WW Soon MS Lin YM 2006 Intestinal necrosis as a complication of epinephrine injection therapy during double balloon enteroscopy Endoscopy 38 5 542 doi 10 1055 s 2006 925184 PMID 16586243 Enteroscopy www hopkinsmedicine org November 14 2022 Balloon Assisted Enteroscopy Definition Process amp Recovery Cleveland Clinic Retrieved from https en wikipedia org w index php title Double balloon enteroscopy amp oldid 1219075426, wikipedia, wiki, book, books, library,

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