Policy Number:
Double Balloon Enteroscopy
Version:
1
Ratified by:
NHS Crawley CCG and NHS Horsham and
Mid Sussex CCG Clinical Policies and
Medicines Approval Panel
Name of originator/author:
Clinical Policies and Medicines Approval
Panel
Date issued:
29-01-15
NHSLA Standard (if applicable):
N/A
Standards for Better Health (if applicable):
N/A
Last review date:
27-01-15
Next review date:
Double Balloon Enteroscopy Policy
This policy refers to DBE procedures commissioned at St Mark’s Hospital, London North West
Healthcare NHS Trust. Other providers providing DBE services are not routinely commissioned.
Double balloon endoscopy (DBE) procedures are usually performed to diagnose and treat small
bowel diseases, where standard endoscopic procedures have failed.
Depending on the indication, DBE can avoid the need for repeated hospital admissions, regular
blood and iron transfusions and/or major abdominal surgery in patients who require investigation
(see appendix 1, fig 1) and/or treatment for the following conditions:
•
•
•
•
•
To obtain small bowel biopsies for a histological diagnosis e.g. suspected Crohn’s
Disease, where standard endoscopy* and small bowel imaging has proved inconclusive
and/or is unable to reach the diseased location (see appendix 1, fig 2)
To treat gastro-intestinal bleeding from a small bowel lesion(s) identified at imaging or
video capsule endoscopy
To obtain histology/remove/tattoo a suspected small bowel polyp or tumour that has
been identified at small bowel imaging, where standard endoscopy* has failed and/or is
unable to reach the lesion
Dilatation of a small bowel stricture(s) identified at small bowel imaging in patients who
are symptomatic and where standard endoscopy* has failed and/or is unable to reach
the site of the stricture
To insert or replace a percutaneous endoscopic jejunal feeding tube in patients who
have failed or are unable to tolerate PEG** feeding and need long-term nutritional
support
Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group
* standard endoscopy = OGD/push enteroscopy and ileo-colonoscopy
** PEG = percutaneous endoscopic gastrostomy
DBE allows pan-enteroscopy i.e. complete endoscopic visualisation of the small bowel, via a
combination of oral and rectal approaches, and is vastly superior to push enteroscopy in terms of
insertion depth and diagnostic yield.
The diagnostic yield from DBE is reported as 43-83%, with a subsequent change in management
of 57-84% of patients.1
In cases where surgery may still be required e.g. small bowel tumours/sub-mucosal lesions, DBE
is useful to obtain histology and/or localise and mark the location of the lesion within the small
bowel for the surgeon with an Indian ink tattoo.
References:
1. British Society of Gastroenterology. Guidelines on small bowel enteroscopy and capsule
endoscopy in adults. Sidhu et al. Gut. 2008
2. Pohl J. European Society for Gastrointestinal Endoscopy Guidelines: flexible enteroscopy
in small−bowel diseases. Endoscopy 2008; 40: 87: 609±618
3. NICE. 2004. IPG 101. Wireless capsule endoscopy for investigation of the small bowel –
guidance
Appendix 1
Figure 1. The use of DBE in obscure gastrointestinal bleeding1
Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group
Figure 2. The use of DBE in the investigation of Crohn’s disease1
Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group