Double-balloon enteroscopy: Difference between revisions

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[[Image:Double balloon normal SB mucosa.jpg|right|thumb|150px|Endoscopic image of normal [[small bowel]].]]
[[Image:Double balloon normal SB mucosa.jpg|right|thumb|150px|Endoscopic image of normal [[small bowel]].]]


D'''ouble-balloon enteroscopy''', also known as '''push-and-pull [[enteroscopy]]''' is an [[endoscopy|endoscopic]] technique for visualization of the [[small bowel]]. It was developed by [[Hironori Yamamoto]] in 2001.<ref name=Yam1>Yamamoto H, Sekine Y, Sato Y, Higashizawa T, Miyata T, Iino S, Ido K, Sugano K. Total enteroscopy with a nonsurgical steerable double-balloon method. ''Gastrointest Endosc.'' 2001 Feb;53(2):216-20. PMID 11174299 </ref> It is novel in the field of diagnostic [[gastroenterology]] as it is the first endoscopic technique that allows for the entire [[gastrointestinal tract]] to be visualized in real time. <ref name=Yam2>Yamamoto H, Sugano K. A new method of enteroscopy—the double-balloon method. ''Can J Gastroenterol.'' 2003 Apr;17(4):273-4. PMID 12704472</ref>
D'''ouble-balloon enteroscopy''', also known as '''push-and-pull [[enteroscopy]]''' is an [[endoscopy|endoscopic]] technique for visualization of the [[small bowel]]. It was developed by [[Hironori Yamamoto]] in 2001.<ref name=Yam1>{{cite journal | pmid = 11174299 }}</ref> It is novel in the field of diagnostic [[gastroenterology]] as it is the first endoscopic technique that allows for the entire [[gastrointestinal tract]] to be visualized in real time.<ref name=Yam2>{{cite journal | pmid = 12704472 }}</ref>


==Technique==
==Technique==
The technique involves the use of a [[balloon]] at the end of a special [[enteroscope]] camera and an overtube, which is a tube that fits over the endoscope, and which is also fitted with a balloon.<ref name=Yam2/> The procedure is usually done under general [[anesthesia]], but may be done with the use of [[sedation|conscious sedation]].<ref>May A, Nachbar L, Wardak A, Yamamoto H, Ell C. Double-balloon enteroscopy: preliminary experience in patients with obscure gastrointestinal bleeding or chronic abdominal pain. ''Endoscopy''. 2003 Dec;35(12):985-91. PMID 14648408</ref> The enteroscope and overtube are inserted through the [[mouth]] and passed in conventional fashion (that is, as with [[gastroscopy]]) into the [[small bowel]].<ref name=Yam1/> Following this, the endoscope is advanced a small distance in front of the overtube and the balloon at the end is inflated. Using the assistance of friction at the interface of the enteroscope and intestinal wall, the small bowel is accordioned back to the overtube. The overtube balloon is then deployed, and the enteroscope balloon is deflated. The process is then continued until the entire small bowel is visualized.<ref>Yamamoto H, Yano T, Kita H, Sunada K, Ido K, Sugano K. New system of double-balloon enteroscopy for diagnosis and treatment of small intestinal disorders. ''Gastroenterology''. 2003 Nov;125(5):1556 PMID 14628813</ref>
The technique involves the use of a [[balloon]] at the end of a special [[enteroscope]] camera and an overtube, which is a tube that fits over the endoscope, and which is also fitted with a balloon.<ref name=Yam2/> The procedure is usually done under general [[anesthesia]], but may be done with the use of [[sedation|conscious sedation]].<ref>{{cite journal | pmid = 14648408 }}</ref> The enteroscope and overtube are inserted through the [[mouth]] and passed in conventional fashion (that is, as with [[gastroscopy]]) into the [[small bowel]].<ref name=Yam1/> Following this, the endoscope is advanced a small distance in front of the overtube and the balloon at the end is inflated. Using the assistance of friction at the interface of the enteroscope and intestinal wall, the small bowel is accordioned back to the overtube. The overtube balloon is then deployed, and the enteroscope balloon is deflated. The process is then continued until the entire small bowel is visualized.<ref>{{cite journal | pmid = 14628813 }}</ref>


The double-balloon enteroscope can also be passed in retrograde fashion, through the [[Colon (anatomy)|colon]] and into the [[ileum]] to visualize the end of the small bowel.<ref name=Yam1/>
The double-balloon enteroscope can also be passed in retrograde fashion, through the [[Colon (anatomy)|colon]] and into the [[ileum]] to visualize the end of the small bowel.<ref name=Yam1/>
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==Indications==
==Indications==
Double-balloon enteroscopy has found a niche application in the following settings:
Double-balloon enteroscopy has found a niche application in the following settings:
*bleeding from the gastrointestinal tract of obscure cause<ref>Yen HH, Chen YY, Soon MS, Lin YM. An unusual cause of obscure gastrointestinal bleeding. ''Gut.'' 2006 Feb 28 E-pub. PMID 16507584</ref>
*bleeding from the gastrointestinal tract of obscure cause<ref>{{cite journal | pmid = 16507584 }}</ref>
*[[iron deficiency anemia]] with normal [[colonoscopy]] and gastroscopy<ref>Chan AO, Lai KC. A patient with long-standing iron-deficient anemia. ''Nat Clin Pract Gastroenterol Hepatol.'' 2006 Feb;3(2):112-6. PMID 16456577</ref>
*[[iron deficiency anemia]] with normal [[colonoscopy]] and gastroscopy<ref>{{cite journal | pmid = 16456577 }}</ref>
*visualization and therapeutic intervention on abnormalities seen on traditional small bowel imaging<ref name=Yam3>Kita H, Yamamoto H. Double-balloon endoscopy for the diagnosis and treatment of small intestinal disease. ''Best Pract Res Clin Gastroenterol.'' 2006 Feb;20(1):179-94. PMID 16473807</ref>
*visualization and therapeutic intervention on abnormalities seen on traditional small bowel imaging<ref name=Yam3>{{cite journal | pmid = 16473807 }}</ref>
*[[ERCP]] in post-surgical patients with long afferent limbs<ref>Mönkemüller K, Bellutti M, Neumann H, Malfertheiner P.Therapeutic ERCP with the double-balloon enteroscope in patients with Roux-en-Y anastomosis. ''Gastrointest Endosc.'' 2008 May;67(6):992-6. PMID: 18279869</ref>
*[[ERCP]] in post-surgical patients with long afferent limbs<ref>{{cite journal | pmid = 18279869 }}</ref>


==Advantages and disadvantages==
==Advantages and disadvantages==
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Double-balloon enteroscopy offers a number of advantages to other small bowel image techniques, including [[barium meal|barium]] imaging, [[wireless capsule endoscopy]] and [[push enteroscopy]]:
Double-balloon enteroscopy offers a number of advantages to other small bowel image techniques, including [[barium meal|barium]] imaging, [[wireless capsule endoscopy]] and [[push enteroscopy]]:
*it allows for visualization of the entire small bowel to the [[terminal ileum]]<ref name=Yam1/>
*it allows for visualization of the entire small bowel to the [[terminal ileum]]<ref name=Yam1/>
*it allows for the application of therapeutics<ref>{{cite journal | pmid = 15549455 }}</ref>
*it allows for the application of therapeutics<ref>Nishimura M, Yamamoto H, Kita H, Yano T, Sunada K, Miyata T, Sugimoto T, Iino S, Sekine Y, Iwamoto M, Ohnishi N, Kuno A, Ohnishi H, Sakurai S, Ido K, Sugano K. Gastrointestinal stromal tumor in the jejunum: diagnosis and control of bleeding with electrocoagulation by using double-balloon enteroscopy. ''J Gastroenterol.'' 2004 Oct;39(10):1001–4. PMID 15549455</ref>
*it allows for the sampling or [[biopsy]]ing of small bowel [[mucosa]], for the resection of [[polyp (medicine)|polyps]] of the small bowel,<ref>Ohmiya N, Taguchi A, Shirai K, Mabuchi N, Arakawa D, Kanazawa H, Ozeki M, Yamada M, Nakamura M, Itoh A, Hirooka Y, Niwa Y, Nagasaka T, Ito M, Ohashi S, Okamura S, Goto H. Endoscopic resection of Peutz-Jeghers polyps throughout the small intestine at double-balloon enteroscopy without laparotomy. ''Gastrointest Endosc.'' 2005 Jan;61(1):140-7 PMID 15672077</ref> and in the placement of [[stent]]s or [[Vasodilation|dilatation]] of [[stenosis|stricture]]s of the [[small bowel]].<ref name=Yam3/>
*it allows for the sampling or [[biopsy]]ing of small bowel [[mucosa]], for the resection of [[polyp (medicine)|polyps]] of the small bowel,<ref>{{cite journal | pmid = 15672077 }}</ref> and in the placement of [[stent]]s or [[Vasodilation|dilatation]] of [[stenosis|stricture]]s of the [[small bowel]].<ref name=Yam3/>
*it allows for access to the papilla in patients with long afferent limbs after Billroth II antrectomy.
*it allows for access to the papilla in patients with long afferent limbs after Billroth II antrectomy.


The key disadvantage of double-balloon enteroscopy is the time required to visualize the small bowel; this can exceed three hours, and may require that patients be admitted to [[hospital]] for the procedure. <ref>Lo SK, Mehdizadeh S. Therapeutic uses of double-balloon enteroscopy. ''Gastrointest Endosc Clin N Am.'' 2006 Apr;16(2):363-76. PMID 16644464. </ref> There have also been case reports of [[acute pancreatitis]]<ref>Honda K, Mizutani T, Nakamura K, Higuchi N, Kanayama K, Sumida Y, Yoshinaga S, Itaba S, Akiho H, Kawabe K, Arita Y, Ito T. Acute pancreatitis associated with peroral double-balloon enteroscopy: a case report. ''World J Gastroenterol.'' 2006 Mar 21;12(11):1802–4. PMID 16586559</ref> and intestinal necrosis<ref>Yen HH, Chen YY, Su WW, Soon MS, Lin YM. Intestinal Necrosis as a Complication of Epinephrine Injection Therapy During Double-Balloon Enteroscopy. ''Endoscopy''. 2006 Feb 20 e-pub. PMID 16586243</ref> associated with the technique.
The key disadvantage of double-balloon enteroscopy is the time required to visualize the small bowel; this can exceed three hours, and may require that patients be admitted to [[hospital]] for the procedure.<ref>{{cite journal | pmid = 16644464 }}</ref> There have also been case reports of [[acute pancreatitis]]<ref>{{cite journal | pmid = 16586559 }}</ref> and intestinal necrosis<ref>{{cite journal | pmid = 16586243 }}</ref> associated with the technique.


==References==
==References==
{{Reflist}}
<div class="references-small"><references /></div>


[[Category:Gastroenterology]]
[[Category:Gastroenterology]]

Revision as of 19:20, 1 December 2010

Endoscopic image of normal small bowel.

Double-balloon enteroscopy, also known as push-and-pull enteroscopy is an endoscopic technique for visualization of the small bowel. It was developed by Hironori Yamamoto in 2001.[1] It is novel in the field of diagnostic gastroenterology as it is the first endoscopic technique that allows for the entire gastrointestinal tract to be visualized in real time.[2]

Technique

The technique involves the use of a balloon at the end of a special enteroscope camera and an overtube, which is a tube that fits over the endoscope, and which is also fitted with a balloon.[2] The procedure is usually done under general anesthesia, but may be done with the use of conscious sedation.[3] The enteroscope and overtube are inserted through the mouth and passed in conventional fashion (that is, as with gastroscopy) into the small bowel.[1] Following this, the endoscope is advanced a small distance in front of the overtube and the balloon at the end is inflated. Using the assistance of friction at the interface of the enteroscope and intestinal wall, the small bowel is accordioned back to the overtube. The overtube balloon is then deployed, and the enteroscope balloon is deflated. The process is then continued until the entire small bowel is visualized.[4]

The double-balloon enteroscope can also be passed in retrograde fashion, through the colon and into the ileum to visualize the end of the small bowel.[1]

Indications

Double-balloon enteroscopy has found a niche application in the following settings:

  • bleeding from the gastrointestinal tract of obscure cause[5]
  • iron deficiency anemia with normal colonoscopy and gastroscopy[6]
  • visualization and therapeutic intervention on abnormalities seen on traditional small bowel imaging[7]
  • ERCP in post-surgical patients with long afferent limbs[8]

Advantages and disadvantages

Endoscopic image of polyp in small bowel detected on double-balloon enteroscopy.

Double-balloon enteroscopy offers a number of advantages to other small bowel image techniques, including barium imaging, wireless capsule endoscopy and push enteroscopy:

  • it allows for visualization of the entire small bowel to the terminal ileum[1]
  • it allows for the application of therapeutics[9]
  • it allows for the sampling or biopsying of small bowel mucosa, for the resection of polyps of the small bowel,[10] and in the placement of stents or dilatation of strictures of the small bowel.[7]
  • it allows for access to the papilla in patients with long afferent limbs after Billroth II antrectomy.

The key disadvantage of double-balloon enteroscopy is the time required to visualize the small bowel; this can exceed three hours, and may require that patients be admitted to hospital for the procedure.[11] There have also been case reports of acute pancreatitis[12] and intestinal necrosis[13] associated with the technique.

References

  1. ^ a b c d . PMID 11174299. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  2. ^ a b . PMID 12704472. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  3. ^ . PMID 14648408. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  4. ^ . PMID 14628813. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  5. ^ . PMID 16507584. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  6. ^ . PMID 16456577. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  7. ^ a b . PMID 16473807. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  8. ^ . PMID 18279869. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  9. ^ . PMID 15549455. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  10. ^ . PMID 15672077. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  11. ^ . PMID 16644464. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  12. ^ . PMID 16586559. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
  13. ^ . PMID 16586243. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
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