Balloon-Assisted Enteroscopy - An Overview

Introduction

Balloon-assisted enteroscopy is also called a deep enteroscopy or balloon enteroscopy. It is one of the nonsurgical methods used to examine the entire portion of the gastrointestinal tract. The small intestine is the longest organ of the digestive system. Since it contains many creases and folds, other nonsurgical instruments like endoscopes are not flexible enough to reach the entire length of the small intestine. So enteroscope are used as they are twice as long as endoscopes.

What Is Balloon-Assisted Enteroscopy?

Balloon-assisted enteroscopy is a technique done to examine and treat conditions that occur in the small intestine. It is performed using a long thin tube having a balloon and camera at its tip to assess the small intestine. This instrument can remove polyps, stop bleeding, and take biopsies.

How Does Balloon-Assisted Enteroscopy Work?

A balloon enteroscopy contains an enteroscope (a thin long tube) with a high-resolution camera, one or two balloons, and tiny instruments at its tip. The specialist will pass the enteroscope through the mouth or the anus to reach the small intestine. The balloon portion inflates, deflates, and creates a passage for the enteroscope to reach the entire intestine area.

What Are the Types of Balloon-Assisted Enteroscopy?

Balloon-assisted enteroscopy can be of three types:

• Single-Balloon Enteroscopy - Single and double balloon enteroscopy uses a thin enteroscope within the long overtube and is safe and effective in viewing the intestines. The only difference between these techniques is how each scope reaches the bowel region. In single-balloon enteroscopy, the enteroscope has a flexible tip and contains only one balloon. The tip anchors the enteroscope as it moves through the bowel area.

• Double-Balloon Enteroscopy - Here, the balloon acts as an anchor in double-balloon enteroscopy, whereas the tip helps the enteroscope advance. The double-balloon enteroscope can advance deeper into the smaller intestine than the single-balloon enteroscope. This deeper advancement can help with further examination of the small intestine area. Double balloon enteroscopy is also called a push-and-pull enteroscopy.

• Spiral Enteroscopy - A special tube containing a rotating spiral is placed over the endoscope. The spiral rotation allows the endoscope to move back and forth in the small intestine. A small motor is fixed to the spiral, allowing the doctor to engage in the spinning mechanism.

When Is Balloon-Assisted Enteroscopy Required?

Balloon-assisted enteroscopy is mainly done to identify and manage the source of intestinal bleeding. It is also used to diagnose and manage polyps in the small intestine, tumors, partial obstructions like strictures (abnormal narrowing), retained foreign bodies, and when the abnormal intestinal anatomy prevents procedures like endoscopy or small bowel capsules. It is also required to place a hollow cylinder or stent; to open or widen a section of the small intestines. Balloon-assisted enteroscopy can also be used with imaging scans like computer tomography (CT) or capsule endoscopy to get a detailed view of intestinal areas requiring treatment. In video capsule endoscopy, the patients are requested to swallow a capsule containing a camera. This camera takes pictures as it passes through the gastrointestinal tract; these pictures are used to examine the small intestine. This technique can examine the entire length of the small intestine.

How to Prepare for Balloon-Assisted Enteroscopy?

• The patient will be given specific instructions to prepare before the enteroscopy procedure. Instruction will usually include diet, fasting, medication restrictions, and bowel preparation.

• If the enteroscopy is done to examine the upper portion of the small intestine (anterograde), the endoscope is usually inserted through the esophagus.

• This procedure requires a liquid diet which has to be started in the afternoon, a day before, and two hours before the procedure.

• If the enteroscopy is done to examine the lower portion of the small intestine (retrograde), the endoscope is inserted through the anal region.

• For this procedure, the patient should consume laxatives and electrolyte drinks for bowel cleansing diarrhea a day before.

• The doctor will also recommend stopping certain medications like diabetic medications, iron supplements, or blood thinners. If the patient fails to prepare for the procedure, it will cause difficulty, and the procedure won't be completed.

What Happens During a Balloon-Assisted Enteroscopy?

• Medications or general anesthesia will be given to block sensations temporarily, and it will help the patient relax and be put to sleep.

• The enteroscope will then pass through the mouth or the anal region and advance into the small intestine region.

• If the endoscope is passed through the mouth, it can advance from an average of 220 to 360 cm into the smaller intestine; when passed through the anus, they advance from 120 to 180 cm into the small intestine. Anterograde procedures usually take 15 minutes lesser than retrograde, and the maximum depth inserted was two times greater than the retrograde procedure.

• Anesthesia is sprayed into the mouth region to suppress gag reflexes or cough when the endoscope is inserted. During the procedure, a mouth gag is also placed to protect the teeth and the endoscope.

• The doctor will then repeatedly inflate and deflate the balloon.

• Every time the balloon inflates and deflates, the enteroscope will advance to a short distance from the small intestine.

• It will take around two hours for the entire small intestine region to be accessed by the enteroscope.

• By using fluoroscopy or X-ray guidance, the images obtained from the camera will be examined by the doctor to locate and manage the conditions.

• After examination, the tube is slowly withdrawn by the same inflation and deflation technique.

What Happens After a Balloon-Assisted Enteroscopy?

After the procedure, the patient will be taken to a recovery room. The patient will wake up once the anesthesia effect wears off. The healthcare provider who performed the procedure will give discharge instructions and explain the procedure's results. If a biopsy is performed during the procedure, the results will be obtained after a week.

What Are the Risks Associated With Balloon-Assisted Enteroscopy?

A balloon-assisted enteroscopy is generally safe. However, rarely, certain risks can happen during the recovery stage, which include sore throat following the anterograde enteroscopy, upset stomach, abdominal discomfort, cramping or bloating due to gas, bowel perforation (tear in the lining of the small intestine), pancreatitis, and certain risks of anesthesia like headaches, low body temperature, slowness in breathing, minor differences in heart rate and blood pressure, and nausea and vomiting.

Conclusion

Balloon-assisted enteroscopy is a non-surgical procedure to access and treat small intestine diseases. This technique can help diagnose intestinal polyps, bleeding, and tumors. The procedure is more gentle on the body than any surgical intervention, so there is less discomfort during the recovery phase. The patients can return to their day-to-day activities within a day after the procedure.