Balloon Assisted or Deep Enteroscopy

A deep enteroscopy, also called a balloon assisted enteroscopy, is a procedure that allows your doctors to examine the small bowel with a long flexible tube known as an endoscope. The special scope has a light and camera attached to its end, as well as inflatable balloons that are used to help move it along the bowel in a push-and-pull technique. The procedure, performed by a gastroenterologist, is used for both diagnosis and treatment of colorectal cancers.

The gastroenterologist inserts an endoscope that has one (single) or two (double) inflatable balloons at the end. The scope is advanced through the small bowel while the balloons are inflated and deflated. This push-and-pull method advances the endoscope through the entire bowel, similar to pulling a curtain over a rod.

The endoscope can be inserted through your mouth (antegrade) or through your rectum (retrograde). Entry through the rectum is more likely if your doctor needs to reach the lower part of the small bowel.

A deep enteroscopy can be done as either an outpatient procedure or in an inpatient setting, under general anesthesia or moderate sedation. During the procedure, your doctor may also use X-rays or fluoroscopy (continuous X-ray imaging on a monitor) to see where the scope is in the gastrointestinal (GI) tract. However, fluoroscopic guidance isn’t used as much as it once was.

You may not be a candidate for this procedure if you have:

• History of extensive abdominal surgeries
• Adhesions or an altered anatomy that would block the scope from advancing
• Other health conditions that would make it dangerous for you to undergo this procedure

Why your doctor may order a deep enteroscopy

A gastroenterologist may recommend this procedure to:

• Find the cause of bleeding in the small intestine
• Diagnose strictures, abnormal tissue, polyps or tumors, including adenocarcinomas, lymphomas, GI stromal tumors and carcinoids 
• Treat or destroy bleeding lesions or opening strictures
• Remove polyps, masses or foreign objects from your bowel
• Biopsy abnormal tissue

Your doctor also may order a deep enteroscopy as a follow-up to findings from an earlier imaging test, such as a capsule endoscopy or a computed tomography (CT) scan.

How to prepare for a deep enteroscopy

If your procedure will be through your mouth:

• You may be instructed to not eat anything for up to 12 hours in advance.
• You also may need some form of bowel preparation. Your care team will give you detailed instructions on diet and what to take beforehand.
• Inform your doctor if you’re allergic to any type of anesthesia.
• Because of the anesthesia, you need to arrange for a ride home after it’s done.
• Tell your doctor about any medications you’re taking and ask whether you should stop them prior to your procedure.
• Let your doctor know if you have any allergies and ask what, if anything, you should do to prevent them from becoming a problem.

For a deep enteroscopy that starts in the rectum, the preparation is the same as for a colonoscopy:

• Tell your doctor about any medications you’re taking and find out when you should stop. Also, inform your doctor if you’re allergic to any type of anesthesia.
• You must empty out your bowel and rectum. Check with your doctor about the best bowel prep for you. This is a liquid solution that you drink before the procedure.
• Don’t eat or drink for several hours before your test. Your doctor will tell you how long you must refrain from food or drink.
• Arrange for someone to take you home, because the test is done under sedation or general anesthesia.

What to expect during a deep enteroscopy

Your procedure may be done under sedation or general anesthesia, so you should not feel discomfort.

The doctor inserts the endoscope either through your mouth or your rectum, depending on where the area of concern is located in your small bowel. How far the scope is inserted depends on what your doctors are looking for.

The procedure can take several hours to perform, regardless of whether it’s a single-balloon or double-balloon enteroscopy. The two procedures are also similar in terms of diagnostic and therapeutic results, how far the scope needs to be inserted, and the rate of adverse effects. Two medical professionals are required to perform a double-balloon enteroscopy.

If necessary, your care team can perform a biopsy of suspicious tissue during the procedure.

You likely can go home afterward unless you have other health issues that require a hospital stay.

Benefits of a deep enteroscopy

• A deep enteroscopy may be useful for patients who cannot undergo video capsule endoscopy.
• This procedure also allows the doctor to perform biopsies without surgery and to mark (tattoo) areas for surgery if necessary.
• It’s also possible to perform treatments such as removing precancerous, early-stage cancer from the digestive tract.

Risks of a deep enteroscopy

Gastrointestinal endoscopic procedures are found to be rather safe.

Still, the risks include:

• Bleeding
• Perforation of the colon
• Complications of sedation, including hypotension, hypertension, cardiac arrhythmias, heart attack, respiratory-related issues, allergic reactions, nausea and vomiting
• Ileus (bowel obstruction) or mild pancreatitis (inflammation of the pancreas), though these are rare

What the results mean

If bleeding is found, it may be possible to treat it at the same time. About 60 percent to 70 percent of patients can be treated during the procedure, according to the American College of Gastroenterology.

Sometimes, the doctor performing the procedure may mark an area with a tattoo to identify that treatment is needed there.

The doctor may also take tissue to be examined under a microscope in a pathology laboratory.

A deep enteroscopy can help detect tumors of the small bowel. The majority of tumors it finds are:

• Adenocarcinomas
• Lymphomas
• Carcinoid tumors
• GI stromal tumors

Tumors—benign and malignant—may need to be removed surgically at another time.

A deep enteroscopy also can sometimes find inflammatory bowel disease, such as Crohn’s disease.

Depending on what’s found, your doctors can discuss your treatment plan with you after they receive the report.