Anyone Familiar W/new Double Balloon Endoscopy??

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Move over Givens Capsule Endoscopy (the camera pill)!!! In 2004 the FDA approved the Fujinon Double-Balloon Electronic Enteroscopy System. The Fujinon is similar to the regular colonoscope that all crohnies know and love (!!?!!). Except the Fujinon allows colonoscopists to view the entire length of the small intestine. The Fujinon has a balloon attached to the end of the scope and another balloon attached to a transparent tube that slides over the length of the scope.

As with a regular colonoscopy the patient is given IV sedation, the Fujinon scope can then be passed thru the mouth or the orifice. It then slowly piggybacks thru the small intestine using a series of balloon inflations and deflations. Each time the overtube and endoscope are inflated and deflated, they advance further into the small intestine. As a problem area is discovered tiny instruments can be advanced by the scopist thru the scope to take biopsies or treat an area of bleeding. If more extensive treatment is needed, the area can be marked for easy location during surgery.

For further information :

http://www.fujinonendoscopy.com/

:melody: :melody: :melody:

Have any of our gastro nurses had the opportunity to observe or take part in the use of this new type of endoscope??

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Hi,

We just got the Givens small bowel capsule system about a month ago. Only a hand full of cases so far, but we have found a couple of bleeding sites. One of our docs brought in a video about the double balloon device. It sounds pretty amazing. It definitely has the upper hand over the pill cam as far as the ability to treat/biopsy. I'll be interested in hearing from people using it too. Take care

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I saw a snippet about this, one of our local docs, not in our facility, is currently using this. My question is that in his TV report he said it inflates the balloons and pulls back the small intestine, then can further advance and do the same again. Is there any concern about how far can you pull back the intestine? It sounds crazy when you think of how long the small bowel is, that it wouldn't create further problems. I obviously have very limited knowledge of this. I am very interested to see how it works.

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I know, I am too. Just talked to my gastro about it yesterday. One of the ways that God managed for us to carry some 20 feet of small intestine and some 5 feet of colon in our abdomen is by creating them like a slinky. Our intestines have muscled areas much like the "ribs" of a slinky. And this double balloon enteroscopy pulls those muscled area "ribs" back and back as the gastro works the scope forward further into the intestines.

And actually this type of scope is done in two parts, starting once at the mouth and later at the orifice (or vice versa) and hopefully they work there way thru to the "middle" so that they have seen it all and haven't missed a few inches or so in the "middle".

That's pretty much all I know about it at this point. Hopefully someone will come along to respond who has been present during such a scope and can clarify things better than my understanding from my gastro.

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I wouldn't count out the pillcam just yet. In fact, capsule endoscopy and double-balloon endoscopy are and should remain complimentary diagnostic tools. There are many clients who just would not be able to tolerate the lengthy DBE procedure, sedation, or lying prone for an hour or more. These people would benefit from capsule endoscopy as a frontline diagnostic tool for small bowel disorders. On the other hand, some patients should not have capsule endoscopy, for example if they have a pacemaker, swallowing disorders, known strictures, etc. Patient selection is very important before any of these procedures are performed. My facility has seen that performing capsule endoscopy before DBE helps with patient selection. Also, keep in mind that reimbursement for DBE is not very good-comparable to that for a colonoscopy, but it may take much longer. :nurse:

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Thanks, DS0659. I would agree that the DBE wouldn't necessarily be a good diagnostic tool, but the ability to allow biopsies, etc. is a great benefit! I wouldn't even agree to the PCE until my gastro got the Agile Patency Capsule for me to take first (I'd had a resection in 1978). Darn glad I did! The APC didn't pass!!! On the other hand, amazingly I've read in the Crohn's forums of a few people who didn't pass the PCE, had no symptoms and month and months later during a routine abdominal xray it was found to still be present in the intestine!!!

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Is this a procedure done in the GI Lab or in the OR?

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At the hospital I used to work at, we did the double ballon endoscopy in one of our larger procedure rooms with Anesthesia present. As it is a new procedure, finding endo clips, forceps and other toolsthat would fit through the scope was a challenge.

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This procedure should be done under anesthesia but is sometimes done under moderate sedation. It is really uncomfortable so have GA is great for the patient. If your facility does double balloon they should have the equipment to fit the scope(long enough).

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