Single Balloon Enteroscopy yields visual, diagnostic tools for disorders of small intestine

The small intestine had long been “uncharted waters” for gastroenterologists due to its extensive length and complex angles and looping. With the advent of video capsule endoscopy (see recent blog post from July 13, 2017, by Dr. Narayani), a need to overcome these obstacles arose. Hence, in 2007, single balloon enteroscopy was developed in Japan.

Currently, GIA is the only group in the Knoxville area that has trained gastroenterologists who perform single balloon enteroscopy. This important skill and expertise allow us to take care of you or your loved one if a small intestinal issue were to arise.

Single balloon enteroscopy (SBE) uses a longer endoscope instrument compared to traditional endoscopy. This endoscope is advanced farther into the small intestine by inflating and deflating an anchoring balloon on a tube, known as an overtube. By performing this advanced maneuver, the bowel is pleated on the overtube, like pushing up a shirt sleeve or pulling a curtain over a rod. The procedure can be performed by starting in the upper GI tract (antegrade) or the lower GI tract (retrograde).

SBE is typically performed to evaluate abnormal findings from other small intestinal exams, such as video capsule endoscopy, CT scan or MRI. Abnormalities include sites of potential gastrointestinal bleeding, polyps or tumors, inflammation in the intestinal lining or retained foreign objects in the small intestine.

SBE is usually performed at the hospital and can be scheduled as either an outpatient or inpatient procedure. Patients have the procedure under general anesthesia and often have no (or minimal) pain or discomfort. Most cases take longer to complete than a normal upper endoscopy or colonoscopy, and complex cases may take up to 2-3 hours. Most are performed through the mouth with no bowel preparation required. Occasionally, the procedure requires starting from the rectum and moving through the colon and into the small intestine (Sorry, in this case bowel prep is needed.)

In comparison to CT/MRI imaging or video capsule endoscopy, SBE offers the advantage of not only visualizing the intestine, but also performing therapeutic maneuvers such as polyp removal or treatment to stop/arrest bleeding. The likelihood of making a significant diagnosis in the small intestine with SBE is quite good at about 75%. In addition, the therapeutic yield (ability to biopsy an abnormality, remove a polyp, stop bleeding, dilate a narrowing or remove a foreign body) is successful in over 50% of patients.   It also has the ability to reach parts of the small intestine that may not be able to be visualized by a video capsule, as often is the case in patients who have surgically altered anatomy. For these reasons, SBE has a high chance of impacting a patient’s intestinal health.

The risks of the procedure are similar to those of standard upper endoscopy and colonoscopy and include bleeding, perforation or sedation complications. Two additional unique risks of SBE include transient slowing of the intestinal movement (also called “ileus”) and pancreatitis, which occurs very rarely (<1%).

If you have questions about this procedure, please talk to your physician or make an appointment to see us.