Double Balloon Enteroscopy: Techniques

Double balloon endoscopy realized endoscopists’ dream of observing the small intestine and providing treatment without excessive stress on patients. Stabilization of the intestine by gripping the intestinal wall with a balloon attached to the distal end of a flexible overtube enables the endoscope to go deeper through the tube by preventing further extension even with bending or looping of the intestine, which is the principle of the double balloon method. In addition, another balloon was attached to the endoscope tip to prevent the withdrawal of the endoscope tip during the advancement of the overtube, resulting in the double balloon endoscope. The endoscope moves forward using two balloons in sequence while folding and shortening the long intestine onto the overtube and making a concentric circle with its shaft. In this article, we will describe the insertion principle, the basis for development of the double balloon endoscope, and detailed insertion procedures with some tips and devices.