Double-balloon endoscopy: past, present, and future |
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Authors: | Keijiro Sunada Hironori Yamamoto |
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Institution: | (1) Department of Internal Medicine, Division of Gastroenterology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan |
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Abstract: | Double-balloon endoscopy (DBE) was developed as a new technique for visualization of and intervention in the entire small
intestine. In DBE, the intestinal walls are held apart by a balloon attached to the distal end of a soft overtube. DBE has
been reported worldwide to be very useful for not only diagnosis but also endoscopic therapy. Biopsy samples of small intestinal
tumors can be obtained using DBE, and the appropriate treatment can be selected before a surgical procedure. For inflammatory
diseases, DBE can reveal the localization of ulcers in the lumen (on the mesenteric or antimesenteric side), which is important
for differential diagnosis. Some endoscopic therapies such as hemostatic procedures, polypectomy, and dilation therapy for
benign strictures can be performed in the same manner as in the large intestine. DBE may also be suitable for colonoscopy
for difficult insertion cases and therapeutic procedures such as endoscopic submucosal dissection. Furthermore, a double-balloon
endoscope can be selectively inserted into the afferent loop to perform endoscopic retrograde cholangiopancreatography in
patients with Roux-en-Y anastomosis, allowing various kinds of endoscopic treatments for biliary diseases to be successfully
performed. Endoscopic therapy in the small intestine, whose wall is very thin, should be performed with special care to avoid
complications such as bleeding and perforation. In the future, improvement is expected in terms of maneuverability, therapeutic
capability, and imaging technology such as the addition of a magnifying function and flexible spectral imaging color enhancement.
We anticipate that DBE will contribute to the establishment of medical science of the small intestine and to research elucidating
the mechanisms of small intestinal diseases. |
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Keywords: | double-balloon endoscopy (DBE) enteroscopy flexible spectral imaging color enhancement (FICE) small intestine |
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