Endoscopists at Penn Medicine are performing balloon-assisted enteroscopy to diagnose and treat patients with disorders of the small bowel. Balloon-assisted enteroscopy permits examination of the small bowel, and, more importantly, tissue diagnosis and the performance of therapeutic interventions to a far greater extent than previously feasible.
At Penn Medicine, balloon-assisted enteroscopy incorporates both single- and double-balloon enteroscopy systems depending on the individual patient and case characteristics. Diagnosis of small bowel disorders is hampered by the relative inaccessibility of the small intestine. Capsule endoscopy permits limited visualization of the small bowel, but does not facilitate precise localization, biopsy, or treatment. Balloon-assisted enteroscopy overcomes these limitations via inflatable components that permit an endoscope to advance through the small bowel in stages.
Through-the–endoscope accessories permit the retrieval of tissue for biopsy, as well as a variety of treatments, including the removal of polyps and other abnormal growths, the dilation of strictures, bleeding cauterization, and pancreaticobiliary therapies in patients with post-operative anatomy.
Currently, Penn endoscopists are performing balloon-assisted enteroscopy for a variety of indications, including: the evaluation of patients with obvious or obscure GI bleeding; iron deficiency anemia in the absence of obvious GI bleeding requiring repeated blood transfusions or iron infusions (i.e. occult GI bleeding); celiac disease with persistent symptoms despite a gluten-free diet; suspected small bowel polyps; genetic disorders (i.e., hereditary colon cancer syndromes, suspected inflammatory bowel disease or Crohn’s disease with small bowel involvement); small bowel strictures requiring dilatation; and the presence of abnormal small bowel radiographs or barium studies and capsule endoscopy that require further evaluation.
Balloon-assisted enteroscopy may also be used to perform ERCP in patients who have post-operative anatomy that does not permit conventional ERCP (i.e. roux-en-Y anastomosis).
Mr. S, a 58-year-old man, was referred to Penn Gastroenterology after experiencing persistent occult GI bleeding for several months attended by pallor, claudication and malaise and resulting in weekly transfusions. Upper endoscopy and colonoscopy studies at another hospital had been negative.
A capsule endoscopy was ordered at Penn that found fresh blood in the jejunum. After a consultation with an endoscopist, Mr. S agreed to have a balloon-assisted enteroscopy. After he was sedated and comfortable, the scope was inserted and advanced into the upper part of the small intestine under fluoroscopic control (similar to standard upper endoscopy) until the site of bleeding in the mid-jejunum was reached (A). A small focus that appeared to ooze blood was then cauterized by inserting a contact thermal probe into the endoscope (B). Increased bleeding after contact assured that this as the bleeding source, and further thermal therapy was applied for hemostasis. To ensure durable hemostasis, the site was further treated with the application of two hemostatic clips. Following the procedure, Mr. S went home, where his symptoms soon resolved. At one year post-procedure, he showed no signs of bleeding.
Team of Faculty
The Division of Gastroenterology at Penn Medicine is comprised of a multidisciplinary team of clinician specialists who treat a variety of digestive, liver and pancreatic disorders. Many Penn gastroenterologists are actively involved in clinical research, as well, pioneering advances within their fields to bring more options to the detection and management of inflammatory bowel disease, Crohn’s disease, celiac disease and gastroesophageal reflux disease and other gastrointestinal disorders. The genetics of gastroenterological disease are a particular focus of research at Penn, as are the effects of comorbid disease and other risk factors.
Performing Balloon-Assisted Enteroscopy at Penn Medicine
Nuzhat Ahmad, MD
Gregory G. Ginsberg, MD
Timothy Hoops, MD
David Jaffe, MD
Michael Kochman, MD
Kashyap Panganamamula, MD
Perelman Center for Advanced Medicine
South Pavilion, 4th Floor
3400 Civic Center Boulevard
Philadelphia, PA 19104
Penn Presbyterian Medical Center
218 Wright Saunders Building
51 N 39th Street
Philadelphia, PA 19104
To refer a patient and/or consult with a physician: Call 800-789-PENN (7366) or visit: PennMedicine.org/referral
The Division of Gastroenterology at Penn is committed to the continuous improvement in the treatment of diseases of the digestive tract, pancreas and liver. Patients who participate in clinical research make such advances possible. The links below can be used to gather information about clinical trials that are currently recruiting participants, as well as past GI research.
Selected current clinical trials include: SyNCH II (NASH)- A multi-center, randomized, double masked, placebo-controlled phase II study to assess the safety and efficacy of a standardized orally administered silymarin preparation (Legalon®) for the treatment of non-cirrhotic patients with non-alcoholic steatohepatitis. Contact: Amy Micheli (firstname.lastname@example.org).
DILIN (Prospective arm) – Continuation and expansion of the drug induced liver injury network for patients who have suffered liver injury from drugs or complementary and alternative medicines in the past six months. Contact: Amina Wirjosemito (email@example.com) .
DILIN (Retrospective arm) – Continuation and expansion of the drug induced liver injury network for patients who have suffered liver injury from isoniazid (INH), phenytoin (Dilantin®), combination clavulanic acid/amoxicillin (Augmentin®), and valproic acid (Depakote®), nitrofurantoin, trimethoprim-sulfamethoxazole, minocycline, and quinolone antibiotics since January 1, 1994. Contact: Amina Wirjosemito (firstname.lastname@example.org).
Download a pdf of this Clinical Briefing.