One of the unique diagnostic tools available for use by our pediatric gastroenterologists is double balloon enteroscopy (DBE), which allows for direct visualization of the entire small intestine with the ability to obtain biopsies if abnormal areas are found, to remove polyps, or to treat a bleeding site. This is done while the child is asleep under anesthesia. A special flexible fiber optic tube (endoscope) is passed through the mouth, down the esophagus, through the stomach and into the duodenum which is the start of the small intestine. From there, using a novel technique with two small balloons attached to the endoscope, the endoscope is carefully advanced through the small intestine.
The small intestine has been inaccessible by standard endoscopic techniques due to the length of the digestive tract and the free floating nature of this part of the digestive tract that. Standard endoscopy can be used to examine the esophagus, stomach and upper duodenum which is approximately three feet in length. Colonoscopy can be used to explore the large intestine and terminal ileum which is approximately four to five feet in length. The small intestine (which can be 25-30 feet in an adult) has only recently been accessible for study thanks to newer methodologies like double balloon enteroscopy and capsule endoscopy.
When the gastroenterologists at Nationwide Children’s first began using double balloon enteroscopy in 2006, it was a relatively new technology that had not been adapted for use in pediatric patients. Since then, it has become more widely recognized as a safe and effective way to address problems in the small intestine not only in adults but in children as well. Nationwide Children’s continues to be one of only a few institutions in the United States to provide both the equipment and expertise in use of double balloon enteroscopy in pediatric patients.