Double-balloon endoscopy: past, present, and future

Abstract

Double-balloon endoscopy (DBE) was developed as a new technique for visualization of and intervention in the entire small intestine. In DBE, the intestinal walls are held apart by a balloon attached to the distal end of a soft overtube. DBE has been reported worldwide to be very useful for not only diagnosis but also endoscopic therapy. Biopsy samples of small intestinal tumors can be obtained using DBE, and the appropriate treatment can be selected before a surgical procedure. For inflammatory diseases, DBE can reveal the localization of ulcers in the lumen (on the mesenteric or antimesenteric side), which is important for differential diagnosis. Some endoscopic therapies such as hemostatic procedures, polypectomy, and dilation therapy for benign strictures can be performed in the same manner as in the large intestine. DBE may also be suitable for colonoscopy for difficult insertion cases and therapeutic procedures such as endoscopic submucosal dissection. Furthermore, a double-balloon endoscope can be selectively inserted into the afferent loop to perform endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y anastomosis, allowing various kinds of endoscopic treatments for biliary diseases to be successfully performed. Endoscopic therapy in the small intestine, whose wall is very thin, should be performed with special care to avoid complications such as bleeding and perforation. In the future, improvement is expected in terms of maneuverability, therapeutic capability, and imaging technology such as the addition of a magnifying function and flexible spectral imaging color enhancement. We anticipate that DBE will contribute to the establishment of medical science of the small intestine and to research elucidating the mechanisms of small intestinal diseases.

Peutz-Jeghers syndrome: Diagnostic and therapeuticapproach

“…Endoscopic therapy in the small intestine, whose wall is very thin, should be performed with special care to avoid complications such as bleeding and perforation [63] .…”

“…DBE and video capsule enteroscopy have changed this approach and it is now possible to not only to perform endoscopic surveillance and diagnose these lesions, but also to resect them [37,58,73,77,78] . Many reports on DBE have suggested that this new method may be able to replace at least IOE in many circumstances [63,79,80] . Indications of IOE have diminished over recent years because of the development of DBE [57] .…”

“…In the series published to date, complications of DBE solely relating to the diagnostic procedure are rare. A recent retrospective multicenter survey in four countries has indicated a complication rate of 0.8% (13/1728) in diagnostic procedures and 4.3% (27/634) for therapeutic DBE, and there were no fatal cases [63,84,85] . During DBE, careful attention must be paid not to insufflate too much air, because this induces intestinal loop formation and impedes deep advancement [73] .…”

Present status and strategy of NSAIDs-induced small bowel injury

“…Recently, the serious problem of NSAIDs-induced small intestinal damage has become a topic of great interest to gastroenterologists, since video capsule endoscopy (VCE) and balloon enteroscopy (BE) are available for the detection of small intestinal lesions [2][3][4]. Such lesions have been of great concern in clinical settings, and their treatment and prevention must be devised as soon as possible.…”

Risk Factors of Acute Pancreatitis in Oral Double Balloon Enteroscopy

“…In our opinion, mechanical stress on the pancreas seems to be presumable. Traumatic injury of the pancreas seems to be the main cause of acute pancreatitis (14,41,44,59,64).…”