Have you been told to have a Balloon Enteroscopy? Don't worry, let's find out!

Sometimes it's a little difficult to find the cause of something like stomach ache or intestinal bleeding, isn't it? Especially if it's a problem in the small intestine, which is deep in our digestive system, it can't be seen with a regular endoscopy. That's when doctors use this special test called "Balloon Enteroscopy." You might feel a little scared when you hear this name. But this is actually a much simpler and safer test than you think. Let's talk about everything clearly and simply.

What is Balloon Enteroscopy in simple terms?

Think of your small intestine as a long, winding road. A standard endoscope camera can only see the first part of this road. That is, past the stomach and into the first part of the small intestine (the duodenum). But if the problem is deeper than that, you need a different way to see it.

That's where balloon enteroscopy comes in. This is also a long, flexible tube. It has a camera and a light at the end. But the special thing is that there are one or two balloons attached to this tube. By inflating and deflating these balloons, this device slowly moves, like a caterpillar, a long way down the small intestine. As it does so, the doctor can clearly see the inside of the intestine with the camera. Simply put, this is a special method used to go deeper into the intestine than a regular camera can go, examine it, and if necessary, treat it there .

Why is the doctor asking you to do this kind of test?

If your doctor has advised you to have this test, there must be a specific reason for it. It is usually done to further investigate a suspected problem in the small intestine that other tests have not found. Here are some of the main reasons.

Are there any types of this? What are single and double balloons?

Yes, there are two main types of this method. Although the basic principle of both is the same, there is a slight difference in the way it works.

Double Balloon Enteroscopy

This is the first and most commonly used method. The device is designed as if there is a "tube inside a tube."

• Inner tube: This is where the camera is located.
• Outer tube/Overtube: This goes over the inner tube.

There are two balloons at the ends of both of these tubes. What the doctor does is inflate one balloon and stop it at one point in the intestine. Then he moves the other tube a little further forward. Then he inflates that balloon and deflates the previously inflated balloon. By alternately inflating and deflating the balloons in this way, the device gradually moves further into the intestine.

Single Balloon Enteroscopy

This is a relatively new method. As the name suggests, it has only one balloon . It is located in the outer tube (overtube). There is no balloon in the inner tube. Instead, it is designed to be bent at the tip and rest on the intestinal wall. The function of the second balloon is done by this bendable tip. Although this method is said to be a bit faster, the most popular and widely used method all over the world and in Sri Lanka is the double balloon method.

How should I prepare before the test?

For this test to be successful, your small intestine must be completely empty and clean. This is when the camera can see inside clearly. To do this, you will need to do the following:

• Liquid diet: Your doctor will tell you to eat only clear liquids for a day or two before the test. This means things like orange juice, water, salted water, plain tea without sugar, and filtered soup. Your doctor will tell you exactly what to drink and when to start.
• Bowel Prep: If the camera is inserted through your rectum (under your rectum), your large intestine and small intestine will need to be completely cleaned out. Just like for a colonoscopy, you will be given a special liquid ( laxative ) to drink to help you pass stool. You will need to go to the bathroom several times after drinking this. It is very important to follow your doctor's instructions exactly.

What really happens during the test?

Don't be afraid of this at all, because you won't feel any pain or discomfort from this.

This test is done under general anesthesia . This means that everything happens while you are sound asleep. When you wake up, everything is over.

The doctor will determine the side where the camera will be inserted based on your symptoms and suspected condition.

1. Oral insertion (Antegrade/Top-down): If a problem is suspected in the upper part of the small intestine, this tube is inserted through the throat.

2. Rectal insertion (Retrograde/Bottom-up): If a problem is suspected in the lower part of the small intestine, the insertion is done through the rectum.

Once the device is inserted, the doctor slowly inflates and deflates the balloon and advances it along the colon. As he goes, he can watch live images of the inside of the colon on a computer screen. If he sees a problem, he can treat it right there.

• You can find where the bleeding is and stop it.
• Something like a tumor or polyp can be removed.
• A small piece of tissue (biopsy) may be taken from a suspicious area for examination.
• A blocked intestine can be dilated or a stent can be placed.

The entire process can take anywhere from one to several hours , depending on how far into the colon you want to see and what type of treatment you want to do.

What are the benefits and risks of this?

Like any medical test, this one has benefits and very minor risks.

What happens after the test? Will I recover quickly?

Yes, definitely. The recovery after this is much faster.

• Waking up: It takes about an hour or two to fully wake up from anesthesia. During that time, you will be kept in an observation ward.
• Finding out the results: After you regain consciousness, the doctor will come to see you and explain to you what was seen during the examination and the treatment that was given.
• Minor discomfort: If the test was done orally, you may have a slight sore throat for about a day. If it was done under the skin, you may feel a feeling of fullness in your stomach. These are normal and will go away completely in a day or two.
• Going home: Most of the time you can go home the same evening .
• The most important thing: The effects of anesthesia can last for about 24 hours. So you may feel a little sleepy and have difficulty concentrating. So, be sure to bring someone to take you home. You will not be able to drive, make important decisions, or operate machinery on your own that day.
• Biopsy results: If a piece of tissue was sent for testing, it can take about a week to receive the report.

So, you can see that this is nothing to be afraid of. This balloon enteroscopy is a very valuable way to find a problem in the small intestine and treat it without having to go through something as major as surgery.