BAE: AN INSERTION TECHNIQUE COMBINING HIGH INTUBATION RATE AND SAFETY

Abstract

BAE, which includes double- and single-balloon systems, is crucial for the diagnosis and treatment of small bowel diseases. Successful intubation into the deep small bowel requires familiarity with device characteristics and meticulous attention to scope configuration and loop management. This review outlined the fundamental principles and practical tips for safe and effective BAE insertion. After appropriate bowel preparation, route selection (oral vs. anal) was guided by capsule endoscopy and cross-sectional imaging for direct access to the target lesion. Insertion involves repeated “fixation-advancement-shortening” maneuvers, alternating balloon inflation and deflation while maintaining a large, smooth, quasi-concentric scope loop under fluoroscopic or tactile guidance. In double-balloon enteroscopy, the tip and overtube balloons are used alternately to anchor and pleat the bowel, whereas in single-balloon enteroscopy, tip angulation and passive bending compensate for the lack of a distal balloon. Awareness of scope shape, early recognition of “empty pushing” and excessive resistance, and timely curve redesign by repositioning the overtube balloon are crucial to avoid perforation and other adverse events. We illustrate practical techniques for one-operator handling and advanced therapeutic strategies, such as marking-clip-assisted hemostasis and gel immersion endoscopy, for small bowel bleeding. We highlight the difficulty of achieving deep proximal ileal healing in Crohnʼs disease and discuss the prognostic implications of persistent small bowel ulcers, underscoring the importance of optimized BAE techniques for diagnosis and treat-to-target management.