Balloon-assisted enteroscopy: unifying double-balloon and single-balloon enteroscopy

Tsujikawa and colleagues have presented a new technique for performing enteroscopy, namely “single-balloon enteroscopy” (SBE) [1]. This technique expands our endoscopic possibilities of exploring and treating diseases of the small bowel. A SBE technique may also be useful to investigate the colon or perform endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y anatomy [2] [3]. Yamamoto et al. described the technique of double-balloon enteroscopy (DBE) in 2001 [4]. Both DBE and SBE have replaced push enteroscopy as the methods of choice for performing deep small-bowel investigation and for carrying out endoscopic interventions within the small intestine. Both SBE and DBE, like push enteroscopy, use the principle of the push-and-pull technique: the endoscope is advanced (pushed), then the overtube is slid towards the tip of the endoscope, and then both endoscope and overtube are pulled back, hence “push and pull”.

When using SBE and DBE, the major factor governing the depth of insertion of the enteroscope is the presence of the balloon on the distal end of the flexible overtube. The overtube stabilizes the intestine, preventing it from bending or looping. Most importantly, the inflated balloon prevents the intestine from sliding forward, keeping it “shortened”. This allows the endoscopist to push firmly on the enteroscope, effectively transmitting forces to the distal end of the endoscope, and hence permitting the advance of the enteroscope deeper into the small intestine without looping or stretching of the proximal intestine [1] [4]. Although DBE has also been called “push-and-pull enteroscopy”, we believe that, based on the above explanation of the basic technical aspects of these procedures, a unifying term for both SBE and DBE should be “balloon-assisted enteroscopy” (BAE).

References

• 1 Tsujikawa T, Saitoh Y, Andoh A. et al . Novel single-balloon enteroscopy for diagnosis and treatment of the small intestine: preliminary experiences.  Endoscopy. 2008;  40 11-15
• 2 May A, Nachbar L, Ell C. Push-and-pull enteroscopy using a single-balloon technique for difficult colonoscopy.  Endoscopy. 2006;  38 395-398
• 3 Mönkemüller K, Fry L C, Bellutti M. et al . ERCP using single-balloon instead of double-balloon enteroscopy in patients with Roux-en-Y anastomosis.  Endoscopy. 2008;  DOI: 10.1055/s-2007-966949
• 4 Yamamoto H, Sekine Y, Sato Y. et al . Total enteroscopy with a nonsurgical steerable double-balloon method.  Gastrointest Endosc. 2001;  53 216-220