Double Balloon Enteroscopy (DBE)

What is Double Balloon Enteroscopy?

Double balloon enteroscopy (DBE), is an endoscopic technique used to view the entire gastrointestinal tract. It is especially used to see the small intestine segments at depths that cannot be reached with normal endoscopy and colonoscopy and to diagnose and treat diseases in this region.

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    How is Double Balloon Enteroscopy Done?

    Technically, double balloon enteroscopy consists of an approximately 2-meter-long endoscopy device with a balloon at its end that can be inflated and deflated, and an overtube (the upper tube at the end that can slide back and forth over the endoscope) placed on this device in a sliding way and also containing a balloon at its end. When one of the balloons is inflated, it serves to keep the endoscope device or ovarian tube fixed in that area so that the other device can move forward more easily. From time to time, while both balloons are inflated side by side, they are both withdrawn and shortening is applied, and the small intestine segment is both shortened and slightly flattened. In this way, it is possible to go further.

    Çift balon enteroskopi
    Step 1: Entering the small intestine
    Çift balon enteroskopi
    Step 2: The first balloon is inflated and fixed. The guide wire is advanced.
    Çift balon enteroskopi
    Step 3: The second balloon is inflated and fixed at the end of the advanced guide wire.
    Çift balon enteroskopi
    Step 4: The first balloon is lowered
    Çift balon enteroskopi
    Step 5: The endoscope is advanced to the second balloon.

    By repeatedly applying these steps, a controlled progress is achieved within the small intestine.

    The procedure is performed under sedation and may take approximately 1 to 3 hours. Double balloon enteroscopy can be performed from the top orally, and if suspicious lesions are in the distal parts of the small intestine, it can also be performed colonoscopically. Whether to approach suspicious lesions from the upper or lower side is usually decided by capsule endoscopy performed before the procedure. It is not considered appropriate to perform double balloon enteroscopy without capsule endoscopy. The purpose of double balloon enteroscopy must be decided before the procedure. It is not a process that can be done lightly. Because there are some important complications such as perforation, bleeding, acute pancreatitis and enteritis.

    Why is Double Balloon Enteroscopy Performed?

    Double balloon enteroscopy is used to examine small bowel segments that cannot be easily reached by endoscopy and colonoscopy in the following situations.
    • In the investigation of blood losses whose cause cannot be found even though other techniques are used
    • In the investigation of unexplained abdominal pain despite the use of other techniques
    • In the treatment of angiodysplasia foci causing bleeding with argon plasma coagulation.
    • Removal of intestinal polyps by polypectomy
    • Biopsies are taken to diagnose conditions such as mucosal damage and Crohn’s disease.
    • Small bowel tumors are marked with permanent dyes called spot markers in the area before surgery to ensure that the surgery is performed laparoscopically.
    • When ERCP is required in people whose anatomy has been changed by stomach surgery

    ERCP with Double Balloon Enteroscopy in altered digestive system anatomy

    In patients who have undergone Billroth II and other gastric bypass operations, reaching the bile duct mouth is not possible with the normal ERCP device due to the changed anatomy. With double balloon enteroscopy, it may be possible to proceed through the changed small intestine anatomy and remove gallstones.

    normal mide
    Normal Stomach
    Billroth 2
    Billroth II
    gastrik bypass
    Gastric bypass

    PEJ Tube Insertion with Double Balloon Enteroscopy

    In patients who cannot feed from the stomach for various reasons and who cannot tolerate feeding through a PEG tube, a percutaneous endoscopic jejunostomy tube can be inserted lower into the jejunum region using double balloon entersoscopy. Just like in the peg tube, the patient can be fed by passing food from outside through the tube directly into the small intestine. Here you can watch the video of inserting the PEJ feeding tube that we previously performed on a double balloon enteroscopy patient.

    Double Balloon Enteroscopy - Frequently Asked Questions

    How long does the Double Balloon Enteroscopy procedure take?

    • DBE transactions can take 1 to 3 hours on average.

    What should be done before double balloon enteroscopy?

    • Before double balloon enteroscopy, it should be determined why the patient will undergo capsule endoscopy or other methods.
    • If used, blood thinners should be stopped at least 5-7 days before the surgery under the supervision of a doctor, and patients should fast for at least 7 hours on the day of surgery.
    • If double balloon enteroscopy will be performed from below through the anus, it is necessary to prepare for colonoscopy in advance.

    Are there any risks to the double balloon enteroscopy (DBE) procedure?

    • Double balloon enteroscopy is generally considered safe. There may be a feeling of pressure or pain after the procedure due to gas distension, which may last for several hours. This situation will be less in the use of carbon dioxide gas. Apart from these, important side effects, although rare, can be listed as bleeding, perforation and acute pancreatitis.

    Is there hospitalization after double balloon enteroscopy?

    • Patients can generally be discharged on the same day

    What should be considered after double balloon enteroscopy?

    • If there is gradually increasing abdominal pain within the first few days, amylase in the blood should be checked for the suspicion of developing acute pancreatitis, and the presence of free air in the abdomen should be investigated by taking a standing direct abdominal X-ray or non-contrast entire abdominal CT in order to detect the risk of perforation.
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