Balloon Enteroscopy

Diagnosing and treating small bowel disease with Balloon Enteroscopy

The small bowel is approximately 20 feet in length and, until recently, has been a relatively inaccessible part of the gastrointestinal tract. The development of video capsule endoscopy made observation of the small bowel possible, but did not allow for lesions and abnormalities to be biopsied or treated. Now, technological advancements in balloon enteroscopy make it possible to biopsy tissue, dilate strictures, remove polyps, and stop bleeding from the small bowel. In some instances, therapy with a balloon assisted scope may allow patients to avoid surgical intervention.

The Procedure

The balloon system consists of a 200 cm endoscope and an overtube. Originally there were two inflatable balloons attached to the scope and/or overtube. Recent technical refinements reduced the number of balloons to one, simplifying the procedure and making it easier to perform.

The technique allows the scope to advance through the length of the small bowel by inflating and deflating the balloon, which grips the walls of the small intestine. With a series of ‘reductions,’ the process pleats the small bowel over the overtube, allowing passage of a small caliber colonoscope deep into the small bowel. Accessories such as biopsy forceps, dilating devices, and cautery probes can be passed through channels in the scope in order to treat abnormal findings in the small intestine.

Balloon enteroscopy can be performed in an outpatient or inpatient setting. It is often performed with general anesthesia, although some patients may require only moderate sedation. Fluoroscopy may be employed during the procedure. Most procedures are performed antegrade, although the retrograde approach may allow better access to lesions in the lower part of the small bowel.

The Risks

The risks of the procedure are similar to those for colonoscopy and upper endoscopy and include bleeding, perforation, and complications of sedation. Unique to balloon enteroscopy are the risks of ileus and pancreatitis, which occur in less than one percent of procedures.

Therapies

Therapies include treatment of bleeding lesions such as angioectasias, dilation of strictures using a hydrostatic balloon dilator, removal by snare or biopsy of polyps or small bowel masses, retrieval and removal of foreign objects or retained capsules, and biopsy of abnormal tissue. Balloon enteroscopy has also been used in gaining access to parts of the gastrointestinal tract in patients with surgically altered anatomy.

Contraindications

Patients who are not medically stable should not undergo balloon enteroscopy. Those who have had extensive abdominal surgeries may be poor candidates because of adhesions or altered anatomy which may prevent the scope from advancing.

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