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Double Balloon Enteroscopy

This flexible endoscope is longer than a typical endoscope and has a device called an overtube. The overtube gives stability to the endoscope and allows doctors to see deep into the small intestine. There is a small balloon at the end of the endoscope and at the end of the overtube. Doctors repeatedly inflate and deflate the balloons to move the endoscope through the small intestine. A double balloon enteroscopy (also called a double balloon endoscopy) helps doctors see areas of the small intestine that typically are not visible with conventional gastrointestinal (GI) endoscopy. Doctors may use a double balloon enteroscopy to diagnose and treat various issues. These include:

• Abnormal tissue or bowel obstruction
• Gastrointestinal bleeding
• Inflammatory bowel disease, such as Crohn’s disease
• Polyps or tumors
• Strictures (narrowing of the intestine)

Children who have an altered intestine, pancreas or liver anatomy due to previous surgeries may need a double balloon enteroscopy for endoscopic retrograde cholangiopancreatography (ERCP), which is a procedure to evaluate or treat problems with the bile ducts or the pancreatic duct.

Single vs. Double

A single balloon enteroscopy only uses one balloon at the end of the overtube. It is simpler to perform than the double balloon enteroscopy, and it may be a shorter one- or two-hour procedure. Doctors may choose a single balloon enteroscopy if the affected area is close to either end of the small intestine, versus deep in the middle.

What to Know Before a Double Balloon Enteroscopy

There are two approaches to this minimally invasive procedure: through the mouth (anterograde, or upper) or through the anus (retrograde, or lower). Doctors choose the approach based on the location of the affected tissue in the small intestine.

Children typically should not eat or drink anything for up to 12 hours before an anterograde or retrograde procedure, which is done the hospital.

A retrograde procedure also requires bowel preparation the day before. Children drink a special solution or take laxatives to flush out poop from their large intestine. They can do this at home.

During a Double Balloon Enteroscopy

Children receive anesthesia to go to sleep so they do not feel any discomfort or pain during a double balloon enteroscopy. Doctors insert the double balloon endoscope into the child’s mouth or anus and guide it to the small intestine.

Next, they inflate the balloon on the overtube, then the balloon on the endoscope, and then they deflate the overtube balloon to advance the endoscope through the small intestine. This push-and-pull technique allows the endoscope to bunch up or fold the small intestine onto the overtube to make it easier to see the entire length.

The endoscopy has a camera and a light so doctors can take pictures of the inside of the intestine. They also can treat bleeding and guide special tools through the endoscope to remove polyps, take small tissue samples or place stents.

A double balloon enteroscopy can take one to four hours, depending on how far doctors have to move the endoscope into the small intestine and the issues they diagnose or treat during the procedure.

Recovery After a Double Balloon Enteroscopy

A double balloon enteroscopy is a safe procedure. After anterograde double balloon enteroscopy, your child may have a sore throat. Children who have had a retrograde double balloon enteroscopy may have an upset stomach, vomiting, bloating or cramping. Most of these side effects are temporary and resolve within a few hours to a day.

There is a risk of bleeding, infection or perforating the small intestine with double balloon enteroscopy. A rare complication is bruising the pancreas and causing acute pancreatitis.

Most children can go home the same day of the procedure. Recovery time varies based on a child’s condition and the specifics of the procedure. Most children return to their normal activities within one to two days.

Doctors typically schedule a follow-up appointment after the procedure to discuss the results and biopsy results if tissue samples were taken.

Long-Term Outlook for Children Who Receive a Double Balloon Enteroscopy

Double balloon enteroscopy is effective for diagnosing and treating a variety of conditions in the small intestine instead of a more invasive surgery.

The long-term outlook for children who receive a double balloon enteroscopy depends on the condition they have, but is typically positive. Some children may need to have the procedure again to monitor treatment, investigate new symptoms, remove new polyps or manage bleeding.