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Introduction to endoscopy
The use of upper and lower gastrointestinal endoscopes has revolutionized the diagnosis and treatment of diseases of the esophagus, stomach, duodenum, and colon (large intestine). The last remaining frontier in the intestines has been the small intestine. Wireless capsule endoscopy allows physicians to visualize the inside of the intestines from the esophagus through to the colon, but capsule endoscopy has limitations, the most notable of which are the inability to control the capsule's passage and to perform therapeutic interventions, such as biopsy and electrocautery. Although capsule endoscopy is likely to remain an important diagnostic procedure because of its simplicity, the limitations of capsule endoscopy have been overcome by the development of balloon endoscopy, also known as enteroscopy.
What is balloon endoscopy?
There are two types of balloon endoscopy: single balloon and double balloon.
Single balloon endoscopy
For single balloon endoscopy, a 200 cm long flexible, fiberoptic, endoscope (a hose-like tube one centimeter in diameter with a light and a camera on the tip) is fitted with an equally long overtube that slides the full length of the endoscope. On the tip of the overtube is a balloon that can be inflated and deflated. The balloon is blown up to anchor the overtube within the intestine. While the overtube is anchored, the endoscope can be advanced further into the small intestine. By withdrawing the overtube the small intestine can be shortened and straightened to make the passage of the inner endoscope easier. The balloon may then be deflated so that the overtube can be inserted further and the endoscope advanced again. The endoscope itself is a standard endoscope with working channels that allow the intestine to be inflated with air, rinsed with water, or used to guide biopsy or electrocautery instruments to the tip of the endoscope.
Double balloon endoscopy
For double balloon endoscopy, similar equipment is used, but a second balloon is located on the tip of the endoscope. Both balloons - the one on the overtube and the one on the endoscope - can be alternatively inflated to anchor the overtube or the endoscope to assist with the passage of the endoscope or overtube, respectively.
What to expect with balloon endoscopy
Balloon endoscopy, like other gastrointestinal endoscopy, requires intravenous sedation. The procedures are long, often requiring 1-3 hours. The most important complications of balloon endoscopy are perforation of the small intestine or bleeding either due to insertion of the endoscope or the use of therapeutic instruments.
What is the future for balloon endoscopy?
Balloon endoscopy is revolutionizing the diagnosis and treatment of small intestinal diseases. Nevertheless, its use is restricted because of the large expenditure of time that is necessary to perform it. Either newer, faster systems will need to be designed or, perhaps, paramedical personnel will be needed to perform the insertions before balloon endoscopy is as commonly performed as other types of endoscopy. For now, when there is concern about disease in the small intestine, wireless capsule endoscopy often is performed first. Then, if abnormalities are found, or if despite a normal capsule endoscopy there still is a strong suspicion that there may be disease in the small intestine, balloon endoscopy is performed.
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Cohen, Jonathan, MD and David A Greenwald, MD, FASGE, FACG. "Overview of upper gastrointestinal endoscopy (esophagogastroduodenoscopy)." UpToDate.com. Updated Aug 4, 2015.
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Abdominal Pain (Causes, Remedies, Treatment)
Abdominal pain can have many causes that range from mild to severe. Some of these causes include bloating, gas, colitis, endometriosis, food poisoning, GERD, IBS (irritable bowel syndrome), ovarian cysts, abdominal adhesions, diverticulitis, Crohn's disease, ulcerative colitis, gallbladder disease, liver disease, and cancers.
Signs and symptoms of the more serious causes include dehydration, bloody or black tarry stools, severe abdominal pain, pain with no urination or painful urination.
Treatment for abdominal pain depends upon the cause.
Bile Duct Cancer (Cholangiocarcinoma)Bile duct cancer (cholangiocarcinoma) is a rare type of cancer that arises from cells that line the drainage system from the liver and gallbladder to the intestine. Symptoms of bile duct cancer include jaundice, itching, weight loss, and abdominal pain. Physical examination, specialized blood tests, and imaging tests may be used to diagnose bile duct cancer. Treatment for bile duct cancer may include chemotherapy, radiation therapy, and photodynamic therapy. Bile duct cancer typically has a poor prognosis. Preventing liver damage may decrease the risk of developing bile duct cancer.
Capsule EndoscopyCapsule endoscopy is a video capsule that is swallowed and takes photographs of the small intestine. Preparation for capsule endoscopy is similar to that of colonoscopy. There are limitations to capsule endoscopy, however capsule endoscopy is generally able to diagnose:
- small intestinal tumors,
- and Crohn's disease.
Colon Cancer PreventionColo-rectal cancer is both curable and preventable if it is detected early and completely removed before the cancerous cells metastasize to other parts of the body. Colonoscopy and flexible sigmoidoscopy (along with digital rectal examination and stool occult blood testing) are both effective at preventing colo-rectal cancers and detecting early colo-rectal cancers.
ColonoscopyA colonoscopy is a procedure whereby a docotor inserts a viewing tube (colonoscope) into the rectum for the purpose of inspecting the colon. Colonoscopy is the best method currently available to diagnose, detect, and treat abnormalities within the colon.
Crohn's DiseaseCrohn's disease is a chronic inflammatory disease, primarily involving the small and large intestine, but which can affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are common symptoms.
Crohns Disease vs Ulcerative Colitis UC
Crohn's disease and ulcerative colitis are diseases that cause inflammation of part of or the entire digestive tract (GI). Crohn's affects the entire GI tract (from the mouth to the anus), while ulcerative colitis or UC only affects the large and small intestine and ilium. Researchers do not know the exact cause of either disease. About 20% of people with Crohn's disease also have a family member with the disease. Researchers believe that certain factors may play a role in causing UC. Both Crohn's disease and ulcerative colitis are a type of inflammatory bowel disease, or IBD.
Crohn's disease and ulcerative colitis both have similar symptoms and signs, for example, nausea, loss of appetite, fatigue, weight loss, episodic and/or persistent diarrhea, fever, abdominal pain and cramping, rectal bleeding, bloody stools, joint pain and soreness, eye redness, or pain. Symptoms unique to Crohn’s disease include anemia and skin changes. Symptoms of unique to ulcerative colitis include, certain rashes, an urgency to defecate (have a bowel movement). Doctors diagnose both diseases with similar tests and procedures. While there is no cure for either disease, doctors and other health care professionals can help you treat disease flares, and manage your Crohn's or UC with medication, diet, nutritional supplements, and/or surgery.
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- staging of cancers of the esophagus, stomach, pancreas and rectum,
- staging of lung cancer,
- evaluating chronic pancreatitis,
- studying gallstones and tumors in the bile duct, gallbladder, and liver,
- evaluating reasons for fecal incontinence,
- and studying submucosal lesions.
- drug reactions,
- and a lump in the skin where the IV was placed.
Endoscopy is a broad term used to described examining the inside of the body using an lighted, flexible instrument called an endoscope. Endoscopy procedure is performed on a patient to examine the esophagus, stomach, and duodenum; and look for causes of symptoms such as abdominal pain, nausea, vomiting, difficulty swallowing, or intestinal bleeding.
Esophagus PictureThe esophagus is a muscular tube connecting the throat (pharynx) with the stomach. See a picture of the Esophagus and learn more about the health topic.
magnesium citrate-oralMagnesium citrate (Citrate of Magnesia, Citroma) is an OTC medicine that retains water in the intestines to relieve constipation. A magnesium citrate supplement is used for treating heartburn. Side effects include abdominal cramps, diarrhea, bloating, and an electrolyte imbalance. Dosage depends whether it is an adult or child being treated. Magnesium citrate interacts with some antibiotics.
Magnesium citrate (Citrate of Magnesia, Citroma) is an over-the-counter medicine that helps relieve and treat constipation. Magnesium citrate supplements also are used for treating heartburn.
Side effects of magnesium citrate include nausea, vomiting, abdominal cramps, diarrhea, bloating, and an electrolyte imbalance.
Dosage of magnesium citrate depends on a person’s age. Magnesium citrate should not be combined with some antibiotics, for example, doxycycline (Vibramycin), tetracycline, minocycline (Minocin), ciprofloxacin (Cipro), and levofloxacin (Levaquin).
polyethylene glycol (peg) 3350-oralPolyethylene glycol 3350 (Miralax, Glycolax) is a drug used to treat occasional constipation and for bowel preparation prior to procedures. Side effects, drug interactions, dosing, storage, and pregnancy and breastfeeding information should be reviewed prior to using this medications.
Push EndoscopyPush endoscopy is a procedure to examine the upper small intestine. Push endoscopy has the ability to reach areas of the small intestine that standard endoscopy or colonoscopy procedures cannot. Biopsies can be taken for disease examination with this procedure.
The Digestion Process (Organs and Functions)Digestion is the complex process of turning the food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food. Learn more about digestion and the body parts that make it possible, including the:
- small intestine,
- liver, and
Upper GI SeriesAn upper gastrointestinal GI series, or barium swallow is a test used in assisting in the diagnosis of upper gastrointestinal diseases or conditions such as:
- hiatal hernias,
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- abnormalities of the muscular wall of the GI tract.