Lifewatch: Double balloon enteroscopy

Reported by Claire Hosmann - email
Posted by Debra Worley - email

(WECT) - The small intestine is an organ that doctors once considered off limits.

Now, there's a new technique that opens the body's locked door and saves patients from undergoing surgery.

With one wedding, two daughters, and eight grandchildren, 63-year-old Joan Goldsack thought she could blame her exhaustion on her busy life.

But she was really suffering from anemia, caused be internal bleeding.

Doctors suspected the problem was inside Joan's small intestine, but navigating the organ is tricky.  It is up to 25 feet long with folds like an accordion.

There is a new medical tool that opens the "blind spot" in the GI track.

The double balloon enteroscope uses two balloons: one at the end of the scope, the other on a tube that slides over the scope.

The tool passes through the patient's mouth and into the GI track.

When inflated, the balloons grip sections of the small intestine and shorten it, giving doctors access to the entire organ.

"The small bowel can be pleated onto this overtube and trapped, and you use a series of pushing, pulling back, trapping. Pushing, pulling back, trapping," said Dr. Anthony Infantolino.

The tool allows doctors to see the problems in the small intestine and fix them at the same time.

In Joan's case, doctors used it to stop the bleeding, which prevented her from needing a major operation.

Joan was able to go home after the two-hour procedure.  Now, she has the energy to keep up with her busy family.

Doctors say for most patients, double balloon enteroscopy is an outpatient procedure.

The tool is also useful in removing polyps and detecting some early cancers.

For more information, please contact:
Thomas Jefferson University Hospital
Rick Cushman, Public Relations
Gastroenterology Clinical Offices, (215) 955-8900

BACKGROUND: With hundreds of bones, organs, and muscles, it is sometimes difficult for doctors to obtain access to every part of the human body. It wasn't until 2001 that they were able to enter and treat problems within the small intestine. The small intestine, or bowel, is an organ located between the stomach and colon. It is broken up into three areas: the duodenum, which absorbs iron, the jejunum, which helps enzyme secretion, and the ilium, which recycles compounds back into the bloodstream. The organ acts to propel food contents forward, digest food, protect against infection, and secrete hormones and intestinal juices. According to Anthony Infantolino, M.D., a gastroenterologist at the Thomas Jefferson University Medical Center at Jefferson Medical College in Philadelphia, Penn., the small bowel is 20 to 25 feet long and roughly three times the height of an adult.

REACHING THE PROBLEM: Traditionally, the small intestine has been a nearly impossible organ to reach. Double balloon enteroscopy (DBE) was developed in Japan in 2001 and now doctors all over the world are using the device to do complete examinations of the small bowel. The device runs through a person's GI track and uses a camera that takes two pictures per second of the intestine. It allows doctors to examine parts of the small bowel that could not usually be reached, diagnose diseases of the small bowel, evaluate the effectiveness of medication on the small intestine, perform therapy and mark the intestine for future surgery.

The camera is attached to the end of an enteroscope, which has a tube fitted over it. The camera and overtube each have a balloon attached to them. The enteroscope and overtube are inserted into the patient through either the mouth or rectum, depending on which part of the intestine needs to be examined. The patient may be sedated or put under general anesthesia during the procedure. As the enteroscope is moved a small distance past the overtube, the balloon at the end of it is inflated. The overtube is then advanced to reach the end of the enteroscope and as the enteroscope's balloon is deflated, the overtube's balloon is inflated. This process moves the small bowel so the device can continue to maneuver through it in this way. The camera has batteries that last for about eight hours. The pictures are transmitted to a box worn on the patient's belt and are then downloaded at the end of the day. Dr. Infantolino says the patient is able to go anywhere they want for eight hours and then return to the doctor's office.

Side effects of the procedure may include abdominal bloating, nausea, minor bleeding and a sore throat, but they are normally mild and go away within 12 to 24 hours. The pleating and trapping of the intestine with the balloons does not damage the bowel in any way because it is made of a very soft and pliable material. Double balloon enteroscopy is not recommended for those who are obese, pregnant, or suffering from serious respiratory disease.