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January 31, 2007

Exploring the body’s “Dark Continent”: New technology at U-M treats GI disorders without surgery

U-M now using double-balloon endoscopy system to diagnosis, treat small intestine disorders; program set to increase patient capacity in May

ANN ARBOR, MI – Capable of traveling beyond the range of an upper gastrointestinal endoscopy and colonoscopy, new high-tech devices at the University of Michigan Health System are making it possible to explore, diagnose and even treat obscure gastrointestinal disorders in the small intestine with minimal discomfort to the patient and without invasive surgical intervention.

Laurel R. Fisher, M.D.The U-M Department of Internal Medicine's Division of Gastroenterology is now in the beginning stages of using double balloon endoscopy technology – a minimally-invasive scope procedure that allows gastroenterologists to visualize the small bowel in real time, as well as perform biopsies and other therapeutic maneuvers without surgery.

Plans are underway to expand the double balloon endoscopy program’s patient capacity in May. UMHS is currently the only hospital in Michigan using double balloon endoscopy.

“Double balloon endoscopy is a significant advancement in patient care at U-M,” says Laurel R. Fisher, M.D., clinical assistant professor, Division of Gastroenterology at the U-M Medical School.

“Using a scope instead of a scalpel to examine, as well as treat problems in the small intestine, will greatly improve the quality of life for our patients and significantly reduce the number of invasive surgical procedures needed to treat small bowel disorders,” she notes.

Before technology like the double balloon endoscopy was available, the small intestine was an uncharted and often unseen territory within the body. Once referred to as the body’s “Dark Continent,”  physicians previously were unable to access the small intestine without surgery –  even colonoscopy and traditional endoscopy procedures were unable to provide a clear view of the small intestine.  
Fisher’s non-invasive exploration of the small intestine began in 2001 when UMHS became the first hospital in Michigan to use capsule endoscopy – a wireless, pill-size camera capable of producing 60,000 digital images of the digestive tract and intestine when swallowed by a patient. From the teeth to the colon, the tiny capsule can record its entire journey though the digestive tract – 25 feet in all – while closely examining the 15 to 18 feet of the small bowel.

Since the program began, more than 1,000 patients have used capsule endoscopy at UMHS.

“The capsule endoscopy system was revolutionary in the diagnosis of small bowel disorders,” says Fisher, director of U-M’s Capsule Endoscopy Program. “It’s allowed us to finally gain a clear view of polyps and other disorders in the small intestine such as bleeding or Crohn's disease. The challenge, however, was that we could see the problems, but couldn’t easily intervene to provide treatment. Surgery was the only option.”

double balloon endoscopy systemNow, with use of double balloon endoscopy on the horizon at U-M, Fisher has the ability to diagnose gastrointestinal disorders in the small intestine, as well as cauterize lesions and perform biopsies of inflammatory lesions like Crohn’s ulcers, or potentially-cancerous tumors. It currently is the only technology available that allows for therapeutic intervention of the small intestine, says Fisher.

The double balloon endoscopy system features two balloons, attached to the end of a scope similar to a colonoscope used for colonoscopies, and the other attached to an overtube, which slides over the endoscope. Once inflated, the balloons hold onto the sides of the bowel and “shorten” the small bowel by pleating it over the endoscope. This allows the scope to advance through the bowel and permits full visualization and therapeutic intervention in the small intestine.

The procedure, typically done in a few hours under conscious sedation, can be performed on adults of any age. Most often, the scope is inserted through the mouth, although Fisher says the system is designed to be passed through the colon too. Before undergoing a double balloon endoscopy, patients most often will need to have a colonoscopy and upper endoscopy, followed by a capsule endoscopy.

Once the program is in full swing in May, Fisher’s goal is to perform 100 to 200 double balloon endoscopy procedures each year.

While double balloon endoscopy and capsule endoscopy provide physicians with detailed images of the gastrointestinal tract, Fisher says they do not replace regular colonoscopy screening procedures, which examine the lining of the colon for abnormalities. Physicians recommend regular colonoscopies for patients over age 50.

To learn more about the services offered by the U-M Department of Internal Medicine's Division of Gastroenterology visit their Web site.

Information about screening colonoscopy

For more information about the double balloon endoscopy system


Written by Krista Hopson


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