What is double balloon enteroscopy (DBE)?

Double balloon enteroscopy is an endoscopic technique that enables a gastroenterologist to examine inside the small bowel very thoroughly. It is often used as a follow-up to capsule endoscopy and is also called push–pull enteroscopy or the 'double bubble' because the shape of the two balloons that are used.

 

What happens during a DBE?

The double balloon enteroscope is inserted through the mouth or the rectum depending on which part of the small bowel needs to be assessed. Carbon dioxide is used to inflate the small bowel to minimise bloating afterwards. Examination, biopsies or any treatment is then performed. Having a DBE may mean that some patients don't need surgery.

 

How long does a DBE take?

A DBE is done as a day-case procedure and takes between 45 minutes and 2 hours depending on why it is being done. It is usually performed under a short-acting general anaesthetic for maximum comfort and to ensure success.

 

Why might you need a DBE?

A double balloon enteroscope can take tissue biopsies or can be used to perform different treatments, all endoscopically. A gastroenterologist performing a DBE can:

• Look at sections of small bowel inaccessible by other methods.
• Assess and diagnose various disorders of the small bowel.
• Investigate abnormalities of the small bowel that have shown up in other tests.
• Find out if medication being used to treat conditions such as Crohn's disease or coeliac disease is working.
• Put tattoos inside the small bowel to mark areas for surgical removal.
• Perform endoscopic treatment.

What should you tell us before a DBE?

Tell your consultant all the medications you take (particularly any blood thinners such as clopidogrel, warfarin, or heparin), or if you are on iron tablets.

Tell us if you have diabetes, as your medication may need to be adjusted on the day of your DBE.

 

How do you prepare for a DBE?

• Decide whether or not you will have sedation. Not all patients need sedation as the procedure is only mildly uncomfortable.
• Do not eat from lunchtime of the day before the procedure. You can take clear fluids but then you must fast overnight. Do not drink anything on the morning of your procedure.

What happens on the day of the DBE?

Come to the endoscopy unit 30 minutes before your DBE. Although we always try to perform your procedure at the agreed time, sometimes there are delays so your time slot cannot be guaranteed. If there is a delay, you will be kept updated.

• When you arrive, you will be seen by one of our nursing team, who will ask you questions about your medical history, medications and allergies. If you have decided to have your colonoscopy with sedation, a small plastic cannula will be inserted into a vein in your arm or hand.
• You will then see your consultant, who will discuss again the details of the planned procedure, including alternatives and risks. You will be asked whether you understand and accept what is planned and we will then need your written consent to go ahead with the DBE.
• If you are given sedation, a small clip is placed on your finger to monitor your pulse rate and oxygen levels. We also give you some extra oxygen via a small tube placed into your nose.
• Carbon dioxide is used to expand the intestine for the doctor to have good views. You may experience some discomfort from time to time but we aim to keep this to a minimum.

Providing treatment using DBE

During a DBE, your gastroenterologist can:

• Stop bleeding from small bowel angioectasias or AV malformations.
• Remove foreign objects or polyps from the small bowel. This is particularly beneficial for patients with polyposis syndromes (e.g. Peutz–Jeghers syndrome or juvenile polyposis).
• Dilate strictures or stenoses (narrowings of the bowel that can cause obstruction) due to Crohn's disease, surgery or medication (such as non-steroidal anti-inflammatory drugs [NSAIDs]).
• Place feeding tubes.
• Take tissue biopsies to help make a diagnosis.

What are the risks of DBE?

Serious complications are extremely rare but these problems may happen:

• A perforation in the wall of the intestine, for example, happens less than once in every 1000 procedures. You are at greater risk if you have a polyp that will need removing or if you have a tight narrowing (a stricture) in part of your bowel. In these more complex cases, the rate of perforation rises to about 1%. If a perforation does occur, you will need to stay in hospital for observation. Only some perforations need to be repaired surgically.
• Significant bleeding following DBE, even with polyp removal, is very rare but slight bleeding can occur at the site of a biopsy. Serious bleeding needs observation in hospital. Very few patients with bleeding need surgery.

 

What happens after a DBE?

Your abdomen may feel sore or bloated for a while. If you have not had sedation you may go home as soon as you wish.

If you have received sedation you should be able to leave when fully awake (usually about an hour), but you must be accompanied by a responsible adult. If you have been sedated:

• Do not drive home or drive for 24 hours.
• Do not operate machinery.
• Do not make any important decisions.

You will be reviewed before going home, to check all is well. Sometimes your consultant can discuss the findings at the time, but biopsy results may take up to four working days to come back. It is best to make another outpatient appointment with your consultant to discuss all the findings.

 

Unwell after your DBE?

Complications are rare but if you experience any of these problems, please seek medical advice and contact us urgently (see below):

• Persistent abdominal pain.
• Light-headedness or fainting.
• Passing blood when you go to the toilet.
• Fever.

Getting more information

If you have any questions concerning your procedure, please contact the gastroenterology/hepatology team at The Physicians' Clinic

The team is available Mon – Fri 0900-1700

Email: gastrohep@thephysiciansclinic.co.uk

Tel: 020 7034 8164

Fax: 020 7034 8140

If you experience problems:

• Contact your consultant directly by telephoning The Physicians' Clinic during office hours as above.
• Out of hours, please contact your gastroenterologist directly using the information supplied after your appointment.