Patient guide · Tests & Procedures
Double-balloon enteroscopy, deep small-bowel endoscopy for obscure GI bleeding, Crohn’s and polyposis.
Double-balloon enteroscopy (DBE) is an advanced endoscopic procedure that reaches deep into the small bowel — beyond the reach of standard gastroscopy and colonoscopy. Modern indication: obscure GI bleeding, Crohn’s of the small bowel, polyposis syndromes, deep small-bowel tumours.
Key facts
- 01
Definition
Deep small-bowel endoscopy using two balloons on a scope and overtube.
- 02
Approach
Antegrade (through mouth) or retrograde (through colon) approach.
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Sedation
Sedation with anaesthetist present.
- 04
Therapy at same visit
Enables biopsy, dilatation and endoscopic haemostasis.
- 05
Complements capsule
Complements capsule endoscopy.
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Specialist setting
Multi-disciplinary specialist gastro / IBD centre.
Preparation
From consultation to recovery — what happens, in order.
Advanced endoscopy pathway, delivered in a specialist gastro or IBD centre.
- 01
Step 1
Consultation
Consultation with advanced endoscopist.
- 02
Step 2
Bowel prep
Bowel prep for retrograde approach.
- 03
Step 3
Fasting
Fasting per standard endoscopy.
- 04
Step 4
Sedation / GA
Sedation / GA.
- 05
Step 5
Balloon advance
Balloon-assisted advance into small bowel.
- 06
Step 6
Biopsy / therapy
Biopsy / therapy as needed.
- 07
Step 7
Post-procedure care
Structured post-procedure care.
What it shows
When double-balloon enteroscopy is the right test.
DBE answers a specific question — what is happening deep in the small bowel, where standard endoscopy cannot reach.
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Angiodysplasia
Obscure GI bleeding — angiodysplasia of the small bowel.
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Small-bowel Crohn’s disease
Direct visualisation and biopsy of small-bowel Crohn’s.
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Small-bowel polyps
Peutz-Jeghers, FAP and other polyposis syndromes.
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Small-bowel tumours
GIST, neuroendocrine tumours and other rare lesions.
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Coeliac disease
Deep biopsy where standard endoscopy is inconclusive.
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Meckel’s diverticulum
Identifies and characterises a Meckel’s diverticulum.
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Post-surgical anastomosis
Assessment of small-bowel anastomoses after surgery.
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Red flag: active bleeding site — endoscopic haemostasis at same procedure
Bleeding lesions can be treated at the same sitting.
Treatment and next steps
What DBE lets your team do next.
Diagnosis, therapy and onward planning — often at the same visit.
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Argon plasma coagulation
For angiodysplasia and other bleeding vascular lesions.
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Polypectomy
Endoscopic removal of accessible small-bowel polyps.
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Balloon dilatation
Dilatation of small-bowel strictures — often Crohn’s-related.
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Biopsy for histology
Targeted tissue sampling for definitive diagnosis.
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Surgical referral
Referral for large or unresectable lesions.
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Iron replacement
For occult bleeding and iron-deficiency anaemia.
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IBD MDT for Crohn’s
Multi-disciplinary planning for small-bowel Crohn’s.
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Familial polyposis surveillance
Structured surveillance in Peutz-Jeghers and FAP.
Safety and red flags
When to escalate, and what to watch for.
DBE is a specialist procedure — these are the situations that need advanced-endoscopy or MDT input.
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Small-bowel bleeding refractory to endoscopy
Persistent bleeding despite endoscopic therapy needs escalation.
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Small-bowel obstruction
Obstruction can complicate deep enteroscopy.
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Perforation post-DBE
Rare but recognised complication requiring urgent assessment.
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Pancreatitis post-DBE
Rare inflammatory complication after antegrade DBE.
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Undiagnosed familial polyposis
Consider hereditary polyposis in unexplained small-bowel polyps.
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Small-bowel adenocarcinoma
Rare but important cause of small-bowel mass or bleeding.
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Neuroendocrine tumour
NETs of the small bowel need dedicated MDT care.
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Small-bowel lymphoma
Suspicion of lymphoma requires haematology referral.
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Post-radiotherapy stricture
Prior pelvic or abdominal radiotherapy raises stricture risk.
Sources
Guidance we’ve drawn on. Reviewed on 2026-07-30.
Reviewed by Pulse Atlas Editorial Board, . Next review 2027-07-30.
- 01 Reference
British Society of Gastroenterology.
British Society of Gastroenterology. - 02 Reference
NICE. Crohn’s disease: management (NG129).
NICE. Crohn’s disease: management (NG129). - 03 Reference
European Society of Gastrointestinal Endoscopy (ESGE) small-bowel guidelines.
European Society of Gastrointestinal Endoscopy (ESGE) small-bowel guidelines. - 04 Reference
American Gastroenterological Association.
American Gastroenterological Association.
Frequently asked
Everything we get asked about double-balloon enteroscopy.
Quick answers on when DBE is right, how it compares with capsule endoscopy, and what the risks are.
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What is double-balloon enteroscopy?
DBE is an advanced endoscopic procedure that uses two balloons — one on the scope and one on an overtube — to advance deep into the small bowel, well beyond the reach of standard gastroscopy or colonoscopy.
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When is DBE the right test?
DBE is indicated for obscure GI bleeding, small-bowel Crohn’s disease, polyposis syndromes such as Peutz-Jeghers and FAP, and small-bowel tumours including GIST and neuroendocrine tumours.
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Antegrade or retrograde — what’s the difference?
Antegrade DBE is performed through the mouth and reaches the proximal and mid small bowel. Retrograde DBE goes through the colon and reaches the distal small bowel. The choice depends on where the suspected lesion sits.
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Is DBE done under sedation?
Yes — DBE is performed under sedation with an anaesthetist present, and general anaesthesia is sometimes used depending on the case and patient preference.
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How does DBE compare with capsule endoscopy?
Capsule endoscopy is a non-invasive first-line test that images the whole small bowel but cannot take biopsies or deliver therapy. DBE is more invasive but allows biopsy, polypectomy, dilatation and haemostasis at the same visit.
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What are the risks of DBE?
Serious complications are uncommon but include perforation, bleeding and, rarely, pancreatitis after antegrade DBE. Any DBE should be done in a specialist gastro or IBD centre by an advanced endoscopist.
Related tests
Looking for a different test?
-
Capsule endoscopy
Wireless small-bowel imaging — often the first-line small-bowel test.
Learn more -
Endoscopy
Upper GI endoscopy for stomach and duodenum.
Learn more -
Colonoscopy
Lower GI endoscopy for the colon and terminal ileum.
Learn more -
All tests
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In practice, in London
Booking double balloon enteroscopy privately in London — what actually happens
With double balloon enteroscopy, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. On the NHS, double balloon enteroscopy typically sits behind a triage step and a wait that can stretch from a few weeks into months. In London’s private sector, the same appointment often lands within days. That speed matters when symptoms are disrupting work, sleep, or a plan you’d already committed to — and it’s the single most common reason people call us in the first place.
In practice, a private double balloon enteroscopy appointment in London means a named consultant, a proper hour in the room (or the equivalent on a video call), and a report you can actually read. Most of the imaging suites and endoscopy units we use sit within a mile of Harley Street or in Chelsea and Fulham, and turnaround on findings is measured in days, not weeks. For double balloon enteroscopy specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
Fit matters more than people expect. For double balloon enteroscopy, the right consultant depends on what you actually need — a second opinion, a definitive diagnosis, a bridge into treatment, or reassurance that nothing’s being missed. We match on that, not on who has the biggest brochure. If a test isn’t the right next step, we’ll say so before you book anything.