About Double Balloon Enteroscopy (DBE)

During a standard upper endoscopy and colonoscopy, most of the gastrointestinal tract is left unexamined. The first part of the small intestine, called the duodenum can be examined during upper endoscopy. The very end of the small intestine, called the terminal ileum, may be reached during colonoscopy. The small intestine is 20 feet in length, however, and most of it cannot be reached.

Double balloon enteroscopy (DBE) is a procedure that enables direct endoscopic examination and intervention within the deeper small intestine. Double balloon enteroscopy makes use of two balloons, one attached to the endoscope tip and the another attached to the tip of a plastic tube placed over the endoscope. When inflated, these balloons grip the wall of the intestine. By inflating and deflating these balloons in proper succession, the endoscope can be maneuvered to shuffle along the small intestine to achieve deep insertion while minimizing the risk of small intestine injury.

Traditionally, surgery has been necessary for diseases affecting the small intestine, such small bowel growths, repeated bleeding from abnormal blood vessels called angioectasias or AVMs (arteriovenous malformations), and blockage from inflammation or scar tissue (small bowel strictures). With the advent of double balloon enteroscopy, these problems can now be treated endoscopically and surgery can often be avoided. 

At Interventional Endoscopy Services, we also routinely perform double balloon enteroscopy to facilitate endoscopic interventions in patients with surgically altered anatomy.

For example, patients with a prior gastric bypass have had the intestines rerouted and a portion of their stomach is no longer directly attached to the esophagus. If problems develop in this excluded portion of the stomach, double balloon enteroscopy may be necessary to reach it and perform successful therapy. 

We frequently also perform endoscopic therapy on the liver and pancreas, since they both directly attach to the small intestine via ducts or tubes that drain bile from the liver and digestive enzymes from the pancreas. After a gastric bypass, the connection of the liver and pancreas to the intestine cannot be reached with normal endoscopes due to the intestine rerouting. Double balloon enteroscopy is one tool we use to achieve successful therapy in this setting. 

This procedure is performed on an outpatient basis using general anesthesia to protect the patient’s airway.  The procedure usually takes 60 minutes to complete.