1. Double BALLOON ENDOSCOPY
Max Brinsmead MB BS PhD
May 2019
Double BALLOON ENDOSCOPY

3. Problem 76 year old male Caucasian with significant GIT haemorrhage
No drugs/medication
Colonoscopy and Oesaphogastroduodenoscopy negative
Capsule Endoscopy (CE) GIT
What might it find?
What are the chances it will find something?
What are the other options?
Relative merits of other investigations?

4. Possible Causes of Small Intestinal Bleeding
Angiodysplasia 50 – 60%
Inflammatory lesions, ulcers and erosions
Includes Crohn’sdisease
Association with NSAID use
More common in Asian series
Polyp (5 – 10%)
Malignancy rare
Includes AdenoCa, Carcinoid and Lymphoma
Diverticula incl. Meckels
Active bleeding without focus

5. Etiology of obscure gastro-intestinal bleeding according to age
Elderly 
Middle-Aged 
Young Adult 
(>65 years) 
(41-65 years) 
(17-40 years) 
Vascular anomalies
Small intestinal ulcer
NSAID enteropathy
Small intestinal tumours
Non-specific enteritis
Celiac disease
Crohn’s disease
Meckel’s diverticulum
Dieulafoy’s lesion

6. Angiodysplasia GIT

7. Capsule Endoscopy

8. Has colour camera, battery, light source and Transmitter
Capsule Endoscopy
Capsule size 26 x 11 mm
Has colour camera, battery, light source and Transmitter
Data recorder worn as a belt
Transit time 24 – 48 hours
Takes 2 images/sec for 8 hours
Will generate 50,000 images
Retention rate 0.4 – 1.4%
Crohn’s is a relative contraindication
Will diagnose a lesion in about 66%

9. Ray’s Capsule Endoscopy

10. “Double Balloon Something or Other”
What is it?
How successful is it likely to be?
Risks and complications?
Other options?

11. Double Balloon Endoscopy
Introduced by Yamamoto in 2001
Allows complete visualization, biopsy and treatment of the small bowel

13. Double Balloon Endoscopy
Essentially 100% successful with no learning curve
75% antegrade
25% retrograde
Takes 45 – 90 min
Can biopsy or snare polyps and argon laser angiodysplasia
Best done with CO2 insufflation
Complications more common with diseased bowel e.g Crohns

15. Meta analysis of Capsule Endoscopy (CE) vs Double Balloon Endoscopy (DBE)
712 patients in 12 studies
Similar diagnostic yields for both when investigating obscure GIT bleeding
DBE better for diagnosing diverticula
CE better for diagnosing fresh bleeding and clots
They are complimentary modalities
And sometimes simply repeating conventional endoscopy is required

16. Other Options for Obscure GIT Bleeding
CT and angiography
Single balloon endosocopy
Spiral endoscopy
Operative endoscopy

17. Any Questions or Comments?
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