Balloon-Assisted Enteroscopy

What is balloon enteroscopy?

Balloon enteroscopy, also known as balloon-assisted enteroscopy or deep endoscopy, is a procedure performed to assess and treat issues in your small intestine. It’s one of the only nonsurgical techniques for examining the entire length of your gastrointestinal (GI) tract.

How does deep endoscopy work?

Balloon enteroscopy uses a long thin tube (enteroscope) with one or two balloons, a high-resolution camera and tiny instruments at the tip. Your gastroenterologist reaches your small intestine by passing the enteroscope down your esophagus or up through your anus. The balloon(s) inflate and deflate, creating a safe passageway for the enteroscope to advance beyond the reach of a non-balloon scope.

Why is this technique necessary?

Your small intestine is approximately 20 feet long. It’s the longest section of your digestive system. It’s narrow, with many folds and creases. Traditional nonsurgical instruments (endoscopes) aren’t long or flexible enough to reach the entire length. Enteroscopes are more than twice as long as traditional instruments.

Why might I need a balloon enteroscopy?

The most common reason is to identify and treat the source of intestinal bleeding.

Other reasons you may need deep endoscopy include diagnosis and management of:

• Small bowel polyps, tumors or other mass lesions.
• Small bowel Crohn’s disease.
• Partial small bowel obstruction such as stricture (an abnormal narrowing of your intestines).
• Abnormal intestinal anatomy that prevents you from having a small bowel capsule, endoscopy or other diagnostic tests.
• Retained foreign bodies.

Who does balloon enteroscopy?

A doctor specializing in gastrointestinal disease (gastroenterologist) performs this procedure.

How do I prepare for a balloon enteroscopy?

Preparing for this procedure requires emptying your small intestine. The method that’s right for you depends on where the enteroscopy will start:

• Upper small intestine (through your esophagus) requires a clear liquid diet starting after noon the day before the procedure up until two hours before the procedure.
• Lower small intestine (through your anus) requires fasting before your procedure. It also involves a complete bowel preparation, like for a colonoscopy. You consume a combination of laxatives and an electrolyte drink to trigger bowel-cleansing diarrhea starting the day before your procedure.

Preparation may also include stopping certain medications like blood thinners, diabetes medications or iron supplements. Tell your healthcare provider about all the medicines you use. They’ll let you know which ones are safe to stop taking.

What happens during balloon enteroscopy?

You receive medication to help you relax or general anesthesia to put you asleep and temporarily block sensation. After passing the enteroscope through your esophagus or anus, your gastroenterologist repeatedly inflates and deflates the balloon(s). Each time the balloon inflates and deflates, the scope advances a short distance. Accessing the entire length of your small intestine can take up to two hours.

What types of tests and treatments might I receive during deep endoscopy?

A balloon enteroscopy may include:

• Examining your small intestine for signs of disease that can include abnormal swelling.
• Identifying the source of and treating internal bleeding.
• Performing cancer screening in people with a family history of inherited small intestinal cancers.
• Removing polyps, other abnormal growths or foreign bodies.
• Taking a biopsy of abnormal tissue so healthcare providers can examine it under a microscope.
• Widening a narrowed area in your intestines (stricture) and keeping it open by implanting a hollow mesh device (stent).

What are the risks and benefits of single or double balloon enteroscopy?

The most significant benefit of this technique is avoiding abdominal surgery. You also avoid the risks that come with major surgery and recovery is faster.

As with any medical procedure, single or double balloon enteroscopy carries certain risks, including:

• Painful gas and abdominal discomfort during recovery.
• Pancreatitis.
• Risks of anesthesia, which include nausea and vomiting, low body temperature and headaches.
• Tear in the lining of your small intestine (bowel perforation).
• Sore throat following oral balloon enteroscopy.

How soon will I receive my results?

You may receive results right after you wake up. If your healthcare provider took a biopsy or removed a polyp, the results are typically available within one week.

What is recovery from deep endoscopy like?

Balloon enteroscopy is an outpatient procedure, so you can go home after the anesthesia wears off. Even if you feel alert, it’s not safe for you to drive on the day of your procedure. You must arrange for a ride home accompanied by a responsible adult.

Once you get home, it’s important to rest. If you had to do bowel prep, you should consume plenty of water and eat nutritious meals. Most people resume regular activities the day after their procedure.

What’s the difference between single balloon enteroscopy and double balloon enteroscopy?

Both single balloon enteroscopy and double balloon enteroscopy are safe and effective ways for your provider to view your intestine. Both procedures use a thin enteroscope within an overtube. The main difference between the two is in how the scope reaches your bowel. In single balloon enteroscopy, the enteroscope has only one balloon and a flexible tip that anchors the scope as it advances through your bowel. Rather than a flexible tip, in double balloon enteroscopy, one balloon acts as an anchor while the other helps the scope advance.

The double balloon enteroscope can typically advance deeper into your small intestine than the single balloon enteroscope, allowing for more frequent examination of your entire small intestine.

A note from Cleveland Clinic

Balloon enteroscopy, or balloon-assisted enteroscopy, is a procedure to assess and treat small intestine disease. The procedure helps diagnose and treat a range of conditions, including intestinal bleeding and polyps. Deep endoscopy is gentler on your body than surgery. You’ll experience less discomfort during recovery and a faster return to daily activities.