Post written by Hironori Yamamoto, MD, PhD, from the Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.

As a developer of double-balloon enteroscopy, I have provided several tips on how to maximize the use of balloon enteroscopy safely and efficiently.

Diagnosis and treatment of small-intestinal disease are sometimes difficult, but with the use of balloon enteroscopy, efficient diagnosis and minimally invasive treatment are possible.

However, it can be time-consuming and associated with a significant risk if used improperly, so I thought it was important to introduce tips on its use.

Preparation is necessary to maximize the use of balloon enteroscopy. It requires collaboration with surgeons and referring physicians. It also is essential to secure sufficient time with good understanding from the endoscopy room staff.

In addition, I mentioned the importance of considering appropriate indications for the procedure and making a comprehensive diagnosis in conjunction with the patient’s medical history and the results of other tests.

Furthermore, it is crucial to know how to select and collaborate with capsule endoscopy. I introduced the use of the endoscopic cap, the water exchange method, and other technical tips.

In terms of safety, the balloon of the balloon endoscope is extremely soft and designed to grip the intestinal tract with minimal pressure to avoid perforation. Even if an excessive insertion force is applied to the endoscope, it just causes slippage of the balloon rather than intestinal perforation.

Therefore, to successfully insert a balloon endoscope, it is necessary to shape the intestine in a way that is favorable for insertion and advance the endoscope with the minimum insertion force necessary.

A, A schema of double-balloon endoscope insertion, forming a concentric circle with the endoscope shaft. B, Fluoroscopic image of the endoscope shaft forming a concentric circle.

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