Small Bowel Enteroscopy
Small bowel enteroscopy or double-balloon enteroscopy (DBE) is a test that uses a long skinny flexible tube with a miniature TV camera, to look at the esophagus, stomach and three to six feet of the small intestine. It is commonly used to help diagnose obscure gastrointestinal bleeding, inflammatory bowel disease, celiac disease, small bowel tumors, and a hereditary condition called polyposis syndromes.
The instrument that is used for this exam is called an enteroscope. The scope is about five feet long and has a flexible plastic overtube with a balloon at the tip. The enteroscope has a balloon at the tip as well and by inflating and deflating these balloons, the enteroscope can be advanced far into the small bowel. The diameter of the enteroscope and the overtube is about the size of a nickel.
Frequently Asked Questions About Small Bowel Enteroscopy
- What preparations are required?
- Can I take my current medications?
- What happens during an enteroscopy?
- What happens after the exam?
- What if the enteroscopy shows something?
- Will I talk with the physician after the procedure?
- What are the possible complications of enteroscopy?
- What if I have other questions or concerns prior to my procedure?
1. What preparations are required?
You will be given written instructions for the enteroscopy (enteroscopy prep planner) that will include diet and other information. Please review this prep planner in advance, follow the instructions closely and call if you have any questions. You must not eat or drink anything for the six hours prior to this exam. You must arrange someone to drive you home after your procedure otherwise the procedure will be cancelled.
Some patients undergoing DBE will be scheduled for the retrograde approach (through the rectum) in order to see the lower small intestine. These patients will need to complete a colonoscopy prep.
2. Can I take my current medications?
Please contact your regular doctor if you are on a blood thinner such as Coumadin, Warfarin, or Plavix. Contact your doctor if you are a diabetic and need to give yourself insulin; do not take any diabetic pills on the day of your procedure. You may take all your other regular medications with a small amount of water. Please bring a detailed list of your regular medications with you on the day of your exam.
3. What happens during an enteroscopy?
You will have a chance to meet with the doctor in the procedure room. He/she will discuss your concerns and explain the risks and benefits of the procedure. You may also meet an anesthesiologist who will administer the sedation if your doctor feels that the exam will require general anesthesia. This is a little more involved than sedation you may have received for other endoscopic procedures, but will put you in a deeper sleep. You are unlikely to experience sensation during the procedure but will likely be fully awake shortly after the completion of the exam. The procedure takes 60 to 90 minutes.
4. What happens after the exam?
You will spend at least 30 minutes in our recovery room and be allowed to rest. The nurses will monitor you while you are in recovery. You may be offered something to drink when you are awake. When you are awake enough to go home, you will be able to get dressed and leave. Even though you feel awake and alert after you leave the clinic, your judgment and reflexes will be impaired for the rest of the day. That is why you must have someone to drive or take you home and it is recommended that someone stay with you for the next several hours. You should be able to eat your normal diet when you return home. You will be able to return to normal activities the next day, unless your doctor gives you other instructions.
5. What if the enteroscopy shows something?
If your doctor sees any area that needs further evaluation, he/she will pass an instrument through the enteroscope to take a biopsy (a small sample of the lining). This tissue will be sent to the lab to be analyzed. Taking a small biopsy will not cause you pain or discomfort. You will be notified of the lab results in about 10 days. If the doctor sees a bleeding site, it may be cauterized (burned) during the exam to reduce the chance of it bleeding again.
6. Will I talk with the physician after the procedure?
Yes, although you may not recall all of the conversation due to the sedation. Your physician will write his/her findings and special instructions on the post-procedure instruction sheet, and a nurse will go over all the findings and instructions with you. You will be provided with the phone numbers to call should you have additional questions.
7. What are the possible complications of enteroscopy?
Enteroscopy is generally a safe procedure. Research studies have shown that the complication rate is approximately 1 in 200. One possible complication is a perforation, or tear, through the bowel wall that could require surgery. Bleeding might occur at the site of biopsy but it's usually minor. Bleeding can stop on its own or be controlled through the enteroscope; it rarely requires follow-up treatment. Rare cases of pancreatitis (swelling of the digestive gland, the pancreas) have been reported with this procedure. Some patients might have a reaction to sedative or complication from heart or lung disease.