From the Guidelines
Double balloon enteroscopy (DBE) has two specific complications not seen with standard esophagogastroduodenoscopy (EGD): pancreatitis and small bowel perforation. These complications are unique to DBE due to its mechanism of action, which involves balloon inflation and advancement of the enteroscope through the small intestine. According to recent studies, such as 1, the management of complications like bleeding from excluded segments of post-RYGB, like gastric remnant and duodenum, can be challenging, and DBE can be used to access these areas, but it carries a risk of perforation, as seen in the use of the double-balloon technique, which has a perforation rate of 10% 1. Some key points to consider about these complications include:
- Pancreatitis occurs in approximately 0.3-0.5% of DBE procedures and is thought to result from mechanical stress on the pancreas during the push-pull maneuvers required for balloon inflation and advancement of the enteroscope.
- Small bowel perforation is another unique complication, occurring in about 0.3% of cases, due to the extensive manipulation of the small intestine during the procedure.
- Patients undergoing DBE should be monitored for abdominal pain, distension, and fever post-procedure, which could indicate these complications.
- Prior abdominal surgeries, inflammatory bowel disease, and radiation enteritis increase the risk of these complications, so extra caution is warranted in these patients. It is essential to weigh the benefits of DBE against the potential risks and to carefully select patients who would benefit from this procedure, taking into account their individual risk factors, as seen in the management of bleeding from excluded segments of post-RYGB, where the use of DBE can be beneficial but also carries a risk of complications 1.
From the Research
Complications of Double Balloon Enteroscopy
Two complications that are specific to double balloon enteroscopy and not to EGD (Esophagogastroduodenoscopy) are:
- Pancreatitis: This is a rare complication of double balloon enteroscopy, with an incidence of 0.3% in most studies 2, 3, 4. The causal mechanism of post-DBE acute pancreatitis is uncertain, but it is thought to be related to mechanical straining of the endoscope with over-tube on the pancreas or in the papillary area 4.
- Perforation: This is another complication that can occur during double balloon enteroscopy, with a higher incidence in patients with altered surgical anatomy undergoing diagnostic retrograde DBE examinations 2. The perforation rate was significantly elevated in patients with altered surgical anatomy, with 7 (3%) perforations occurring in this subset of patients 2.
Comparison to EGD
Double balloon enteroscopy has a higher complication rate compared to standard endoscopic procedures like EGD 2, 3. The complication rate of therapeutic DBE is also higher compared to therapeutic colonoscopy 3.
Key Findings
Key findings from the studies include:
- The incidence of acute pancreatitis after diagnostic DBE is 0.3% in most studies 3, 4.
- The perforation rate is higher in patients with altered surgical anatomy undergoing diagnostic retrograde DBE examinations 2.
- Double balloon enteroscopy is a safe and efficacious method for the study and management of small bowel diseases, with an elevated diagnostic and therapeutic yield 5.