Ballooning Your Way in Altered Anatomy ERCP: Ready for Deductive Learning

Excerpt

In 1987, Lewis et al. used a balloon to 'inchworm' through the small bowel during a time when intraoperative endoscopy and guide-string were the only reliable methods, thus revolutionizing total small bowel visualization and access [1]. Over the next decade, refinements in technology to facilitate endoscopic small bowel access led to the introduction of several deep enteroscopy devices, of which single and deep balloon enteroscopes are the most widely used [2]. Double balloon enteroscopy (DBE) utilizes a specially designed long endoscope (230 cm) with a balloon attachment at the tip, which can be advanced through a long overtube with another balloon on it. After the initial deep advancement with the enteroscope, the distal tip is anchored in place with pressure-monitored balloon inflation, and the overtube is advanced to the tip of the endoscope. The second overtube balloon is then inflated, and the apparatus is gently withdrawn to pleat the small bowel and straighten the loops. Subsequent advancement is done by sequentially deflating balloons, advancing the enteroscope and overtube with repeated reductions, commonly referred to as the “push and pull” technique. Single balloon enteroscopy (SBE) is a modification of the double balloon enteroscopy wherein only the overtube has the balloon and was introduced to streamline this multi-step procedure. …