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>> With enteroscopy, we use a long flexible tube
that we insert into the mouth and it passes into
the small bowel.
Because the small bowel is so long,
push enteroscopy, which is what I just described,
was very limited in its ability to go deep
into the small bowel.
And so, in 2001 in Japan, a new technique was developed
called double balloon enteroscopy.
And with this technique, it uses a balloon
and an overtube to be able to advance more deeply
into the small bowel and to see areas of the small bowel
that were previously inaccessible to us
and this allows us to use non-surgical techniques
and treatments for large polyps and masses
and to do biopsies of lesions very deep in the small bowel.
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With double balloon enteroscopy, it uses an interscope
that has a flexible tube, an overtube,
a flexible overtube with it and it has a balloon
at the end of the overtube and it has
a balloon at the end of the interscope.
And by using both of the overtube and the balloon,
we're able to achieve very deep insertion
into the small bowel.
And the name, double balloon enteroscopy,
actually comes from the two balloons
that are used and that is one balloon
at the tip of the overtube and one balloon
at the tip of the interscope.
The double balloon enteroscopy is performed
by alternately inflating the balloons
at the end of the overtube and the balloon
at the end of the interscope.
By doing that and by pushing and pulling the instrument,
we're able to pleat the small bowel onto the overtube,
and this shortens the length of the small bowel
and allows us to go deeper into the small bowel.
And if you think about sewing, where you have fabric,
that perhaps you're trying to gather onto elastic
or if you have a curtain rod and you're trying
to gather the curtain onto a rod,
that is what we're doing with the small bowel.
But ultimately, by repeating these steps multiple times,
we're able to advance the interscope and the overtube
deep into the small bowel.
Double balloon enteroscopy can be performed
via the upper GI tract through the mouth,
which is called antegrade, or it can be performed
via the lower GI tract through the colon,
which is called retrograde.
In some patients, the entire length of the small bowel
can be evaluated by combining both the antegrade
and the retrograde procedures.
The procedure can be performed as an in-patient
or in patients who are out-patients.
The anesthesia used is usually general anesthesia,
but frequently, moderate sedation can also be used
depending on the clinical scenario.
Sometimes the procedure is performed with fluoroscopy
or X-rays to help identify the location of lesions.
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Double balloon enteroscopy can help patients
who have lesions very deep in the small bowel.
For instance, patients who have
had video capsule endoscopy, which has found
bleeding lesions very deep in the small bowel.
Patients who have had other modalities,
such as CT scans and a polyp or a mass
or a worrisome lesion has been found.
Or a patient who has had a stricture found
on another modality.
Or even a patient who has a foreign body
or a retained video capsule, double balloon enteroscopy
can address all of those issues.
In addition, for patients who
have had surgically altered anatomy,
such as a gastric bypass, double balloon enteroscopy
allows us to access the biliary system
to perform, to remove common bowelic stones
or to place biliary stints as is needed.
So, some patients may need colonoscopy
and upper endoscopy before the double balloon enteroscopy,
but this is not always necessary and depends
on the clinical situation.
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With double balloon enteroscopy,
we're able to treat bleeding lesions,
we're able to dilate strictures,
we're able biopsy to masses, we're able to remove polyps,
we're able to remove foreign bodies,
we're able to remove common bowelic stones
and to place biliary stints.
This technology allows us to offer patients
a non-surgical treatment for many lesions
that are found deep in the small bowel.
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