Double-balloon enteroscopy 5461654 187071852 2008-01-26T18:38:38Z 220.1.190.120 [[Image:Double balloon normal SB mucosa.jpg|right|thumb|150px|Endoscopic image of normal [[small bowel]] [[mucosa]] as seen by double-balloon enteroscopy.]] '''Double-balloon enteroscopy''', also known as '''push-and-pull enteroscopy''' is an [[endoscopy|endoscopic]] technique for visualization of the [[small bowel]]. It was developed by [[Hironori Yamamoto]] in 2001.<ref name=Yam1>Yamamoto H, Sekine Y, Sato Y, Higashizawa T, Miyata T, Iino S, Ido K, Sugano K. Total enteroscopy with a nonsurgical steerable double-balloon method. ''Gastrointest Endosc.'' 2001 Feb;53(2):216-20. PMID 11174299 </ref> It is novel in the field of diagnostic [[gastroenterology]] as it is the first endoscopic technique that allows for the entire [[gastrointestinal tract]] to be visualized in real time. <ref name=Yam2>Yamamoto H, Sugano K. A new method of enteroscopy—the double-balloon method. ''Can J Gastroenterol.'' 2003 Apr;17(4):273-4. PMID 12704472</ref> ==Technique== The technique involves the use of a [[balloon]] at the end of a special [[enteroscope]] camera and an overtube, which is a tube that fits over the endoscope, and which is also fitted with a balloon.<ref name=Yam2/> The procedure is usually done under general [[anesthesia]], but may be done with the use of [[sedation|conscious sedation]].<ref>May A, Nachbar L, Wardak A, Yamamoto H, Ell C. Double-balloon enteroscopy: preliminary experience in patients with obscure gastrointestinal bleeding or chronic abdominal pain. ''Endoscopy''. 2003 Dec;35(12):985-91. PMID 14648408</ref> The enteroscope and overtube are inserted through the [[mouth]] and passed in conventional fashion (that is, as with [[gastroscopy]]) into the [[small bowel]].<ref name=Yam1/> Following this, the endoscope is advanced a small distance in front of the overtube and the balloon at the end is inflated. Using the assistance of friction at the interface of the enteroscope and intestinal wall, the small bowel is accordioned back to the overtube. The overtube balloon is then deployed, and the enteroscope balloon is deflated. The process is then continued until the entire small bowel is visualized.<ref>Yamamoto H, Yano T, Kita H, Sunada K, Ido K, Sugano K. New system of double-balloon enteroscopy for diagnosis and treatment of small intestinal disorders. ''Gastroenterology''. 2003 Nov;125(5):1556 PMID 14628813</ref> The double-balloon enteroscope can also be passed in retrograde fashion, through the [[Colon (anatomy)|colon]] and into the [[ileum]] to visualize the end of the small bowel.<ref name=Yam1/> ==Indications== Double-balloon enteroscopy has found a niche application in the following settings: *bleeding from the gastrointestinal tract of obscure cause<ref>Yen HH, Chen YY, Soon MS, Lin YM. An unusual cause of obscure gastrointestinal bleeding. ''Gut.'' 2006 Feb 28 E-pub. PMID 16507584</ref> *[[iron deficiency anemia]] with normal [[colonoscopy]] and gastroscopy<ref>Chan AO, Lai KC. A patient with long-standing iron-deficient anemia. ''Nat Clin Pract Gastroenterol Hepatol.'' 2006 Feb;3(2):112-6. PMID 16456577</ref> *visualization and therapeutic intervention on abnormalities seen on traditional small bowel imaging<ref name=Yam3>Kita H, Yamamoto H. Double-balloon endoscopy for the diagnosis and treatment of small intestinal disease. ''Best Pract Res Clin Gastroenterol.'' 2006 Feb;20(1):179-94. PMID 16473807</ref> *[[ERCP]] in post-surgical patients with long afferent limbs ==Advantages and disadvantages== [[Image:SB polyp.jpg|right|thumb|150px|Endoscopic image of polyp in small bowel detected on double-balloon enteroscopy.]] Double-balloon enteroscopy offers a number of advantages to other small bowel image techniques, including [[barium meal|barium]] imaging, [[wireless capsule endoscopy]] and [[push enteroscopy]]: *it allows for visualization of the entire small bowel to the [[terminal ileum]]<ref name=Yam1/> *it allows for the application of therapeutics<ref>Nishimura M, Yamamoto H, Kita H, Yano T, Sunada K, Miyata T, Sugimoto T, Iino S, Sekine Y, Iwamoto M, Ohnishi N, Kuno A, Ohnishi H, Sakurai S, Ido K, Sugano K. Gastrointestinal stromal tumor in the jejunum: diagnosis and control of bleeding with electrocoagulation by using double-balloon enteroscopy. ''J Gastroenterol.'' 2004 Oct;39(10):1001–4. PMID 15549455</ref> *it allows for the sampling or [[biopsy]]ing of small bowel [[mucosa]], for the resection of [[polyp (medicine)|polyps]] of the small bowel,<ref>Ohmiya N, Taguchi A, Shirai K, Mabuchi N, Arakawa D, Kanazawa H, Ozeki M, Yamada M, Nakamura M, Itoh A, Hirooka Y, Niwa Y, Nagasaka T, Ito M, Ohashi S, Okamura S, Goto H. Endoscopic resection of Peutz-Jeghers polyps throughout the small intestine at double-balloon enteroscopy without laparotomy. ''Gastrointest Endosc.'' 2005 Jan;61(1):140-7 PMID 15672077</ref> and in the placement of [[stent]]s or [[dilatation]] of [[stricture]]s of the [[small bowel]].<ref name=Yam3/> *it allows for access to the papilla in patients with long afferent limbs after Billroth II antrectomy. The key disadvantage of double-balloon enteroscopy is the time required to visualize the small bowel; this can exceed three hours, and may require that patients be admitted to [[hospital]] for the procedure. <ref>Lo SK, Mehdizadeh S. Therapeutic uses of double-balloon enteroscopy. ''Gastrointest Endosc Clin N Am.'' 2006 Apr;16(2):363-76. PMID 16644464. </ref> There have also been case reports of [[acute pancreatitis]]<ref>Honda K, Mizutani T, Nakamura K, Higuchi N, Kanayama K, Sumida Y, Yoshinaga S, Itaba S, Akiho H, Kawabe K, Arita Y, Ito T. Acute pancreatitis associated with peroral double-balloon enteroscopy: a case report. ''World J Gastroenterol.'' 2006 Mar 21;12(11):1802–4. PMID 16586559</ref> and intestinal necrosis<ref>Yen HH, Chen YY, Su WW, Soon MS, Lin YM. Intestinal Necrosis as a Complication of Epinephrine Injection Therapy During Double-Balloon Enteroscopy. ''Endoscopy''. 2006 Feb 20 e-pub. PMID 16586243</ref> associated with the technique. ==References== <div class="references-small"><references /></div> [[Category:Gastroenterology]] [[Category:Endoscopy]] [[ja:ダブルバルーン小腸内視鏡]]