Double Balloon Endoscopy - During procedure

Double Balloon Endoscopy - Procedure

Double balloon enteroscopy:

• is a day-case procedure • takes between 45 minutes to 2 hours depending on the indication • can be performed under sedation or short acting general anesthesia for maximum comfort • is performed through the mouth or the rectum depending on which part of the small bowel needs to be assessed

During the procedure:

• Carbon dioxide is used to insufflate the small bowel which minimizes bloating • Fluoroscopy (X-rays) may be used to check the position of the DBE • Tissue biopsies are taken • Treatment is performed • Any findings are recorded by photos and DVD

Double Balloon Endoscopy -Indications and after procedure

With DBE it is possible to:

• Examine parts of the small bowel that are usually difficult to reach • Diagnose and assess smalAl bowel diseases and disorders • Investigate the small bowel when X-rays, barium follow through, enteroclysis, CT or MRI scans show abnormalities • Evaluate the effects of medication on the small bowel e.g. for disorders such as Coeliac or Crohn's disease • Tattoo the small bowel to help localise lesions for surgery when these need to be removed • Perform therapy (treatment)

Treatment or therapy using DBE for a number of conditions is available (unlike capsule endoscopy):

• Bleeding from small bowel angioectasias or AV malformations • Removal of foreign objects (e.g. retained capsules) or polyps especially for patients with polyposis syndromes (e.g. Peutz-Jeghers Syndrome or Juvenile Polyposis) • Dilatation of strictures (or stenoses) causing obstruction due to Crohn's disease, surgery or medication (such as NSAIDs) • Placing of feeding tubes (direct jejunostomy)

Double Balloon Endoscopy -Indications and after procedure

With DBE it is possible to:

• Examine parts of the small bowel that are usually difficult to reach • Diagnose and assess smalAl bowel diseases and disorders • Investigate the small bowel when X-rays, barium follow through, enteroclysis, CT or MRI scans show abnormalities • Evaluate the effects of medication on the small bowel e.g. for disorders such as Coeliac or Crohn's disease • Tattoo the small bowel to help localise lesions for surgery when these need to be removed • Perform therapy (treatment)

Treatment or therapy using DBE for a number of conditions is available (unlike capsule endoscopy):

• Bleeding from small bowel angioectasias or AV malformations • Removal of foreign objects (e.g. retained capsules) or polyps especially for patients with polyposis syndromes (e.g. Peutz-Jeghers Syndrome or Juvenile Polyposis) • Dilatation of strictures (or stenoses) causing obstruction due to Crohn's disease, surgery or medication (such as NSAIDs) • Placing of feeding tubes (direct jejunostomy)

Double Balloon Endoscopy (DBE) - Complications

DBE is very safe and serious side-effects or complications are very rare. Common side-effects after a DBE include:

• Sore throat • Abdominal bloating • Nausea • Minor bleeding

These are usually mild and resolve within 12 to 24 hours. The following complications have rarely been reported with DBE:

• Perforation • Major bleeding • Pancreatitis

DBE SYSTEMS

DBE SYSTEMS

Two types of DBE systems are available.

• The standard system includes a thin endoscope with an 8.5 mm diameter and a 200 cm working length (Fujinon EN-450P5), a 145 cm soft overtube with an outer diameter of 12.2 mm, and a specifically designed pump. A soft latex balloon, attached at the tip of the endoscope, can be inflated and deflated using a pump through the air channel in the endoscope. The soft overtube also has a latex balloon at its tip that can be inflated and deflated. The pressure in both balloons is monitored accurately and regulated at 6 kPa.
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• A therapeutic double balloon endoscope (Fujinon EN-450T5) is also available. The Fujinon EN-450T5 has a larger outer diameter (9.4 mm) so that it can accommodate a larger channel (2.8 mm in diameter).