Double-balloon enteroscopy

概述

Double-balloon enteroscopy (DBE) is a procedure used to look inside the small intestine. It is a type of deep enteroscopy, a group of procedures designed to reach areas of the small intestine that standard endoscopy may not reach.

DBE uses a flexible tube called an enteroscope and another tube that goes over it. Each has a balloon that can be inflated and deflated. The balloons work together to help the enteroscope move through the small intestine, also called the small bowel. DBE also can be used to take samples of tissue, called biopsies, and treat certain conditions.

Another form of device-assisted deep enteroscopy is single-balloon enteroscopy.

DBE requires special training and equipment. So it may be offered only in certain medical centers.

Types

Double-balloon enteroscopy can be done in two ways.

• Antegrade double-balloon enteroscopy. The enteroscope enters the mouth and passes through the esophagus. This is the muscular tube that carries food from the mouth to the stomach. The scope then goes through the stomach and into the small intestine. This route is used to reach the upper and middle parts of the small intestine.
• Retrograde double-balloon enteroscopy. The enteroscope enters the rectum and passes through the colon. From there, it enters the lower part of the small intestine.

The route depends on where the suspected area of concern is. Findings from earlier tests may help guide the choice. Sometimes, a healthcare professional may use both routes to look at more of the small intestine. Using both routes most often takes two sessions.

目的

Double-balloon enteroscopy can help diagnose or treat conditions that affect the small intestine, also called the small bowel.

DBE may help find the source of suspected bleeding in the small bowel. It's often done after standard upper endoscopy and colonoscopy haven't found the source. DBE also may be used to evaluate and manage:

• Tumors in the small bowel.
• Inflammatory bowel disease, including Crohn's disease and other conditions that cause swelling and irritation of the digestive tract.
• Malabsorptive disorders, which are conditions that keep the small intestine from taking in nutrients.
• Polyposis syndromes, in which many polyps form throughout the digestive tract.

DBE may be used after a capsule endoscopy. For capsule endoscopy, you swallow a small pill that has a camera. As the camera travels through the body, it takes pictures of the small intestine. Capsule endoscopy can help find the source of certain symptoms, but it can't be used for treatment.

During DBE, the health professional may:

• Take a tissue sample, called a biopsy.
• Treat bleeding.
• Widen a narrowed area called a stricture.
• Remove a foreign object.
• Remove some types of polyps in the small intestine.

风险

Serious complications from double-balloon enteroscopy are not common. Complications may include:

• A tear or hole in the digestive tract, called a perforation.
• Bleeding.
• Pancreatitis, which is swelling and irritation of the pancreas.
• Aspiration pneumonia, a lung infection caused by breathing food, saliva or other substances into the lungs.

The balloons used for DBE are most often made of latex. If you have a latex allergy, you may be at risk of having an allergic reaction.

Your risk of complications depends on your health, the reason for the procedure, the route used and whether you have treatment during DBE. Talk with your care team about your risks.

如何进行准备

How you prepare for double-balloon enteroscopy depends on whether your procedure is antegrade or retrograde. Follow your care team's instructions on how to prepare for your procedure.

For antegrade DBE, you may be asked to fast for at least eight hours before the procedure. You can drink water until two hours before the procedure.

For retrograde DBE, you need to clear stool from the colon. The preparation is like preparation for a colonoscopy. You're likely to start taking the liquids or tablets to clear the bowel the night before the procedure.

For double-balloon enteroscopy, you may have deep sedation or general anesthesia, which puts you in a sleeplike state. This keeps you from feeling pain during the procedure. Before your procedure, be sure to arrange for a ride home after.

可能出现的情况

During the procedure

During DBE, a health professional uses a long, flexible tube called an enteroscope. A second tube, called an overtube, fits over the enteroscope. One small balloon is attached to the enteroscope, and another is attached to the overtube. The balloons inflate and deflate in turns. This helps the health professional move the enteroscope through the small intestine.

After finding an area of concern, the health professional can pass instruments through the enteroscope. The instruments can take a sample of tissue, called a biopsy. They also can control bleeding, widen a narrowed area or do another treatment.

How long the procedure takes varies depending on the route and what needs to be done. A typical procedure takes about an hour.

After the procedure

After a double-balloon enteroscopy, your care team takes you to a recovery room and watches you for about an hour. You may feel sleepy as you recover from the anesthesia. You may have an upset stomach and chills.

If the scope entered through your mouth, you may have a sore throat. If the scope entered through your rectum, you may have gas in your belly. You may have some discomfort after either procedure. Your care team can give you medicine for some of these side effects.

Your care team discusses the results of your procedure with you. If you had a biopsy, lab results may take several days.

You are likely to go home the same day as the procedure. You need to have someone drive you home. Ask your care team when you can return to your regular activities.