Therapeutic Balloon-Assisted Enteroscopy: Recent Advances in the Management of Small Bowel Diseases.

Key Takeaways for GI Nurses

• Balloon-assisted enteroscopy (BAE) has evolved beyond diagnostic use into a primary therapeutic modality for small bowel vascular lesions, hereditary polyposis syndromes, and fibrotic Crohn's strictures—nurses should expect more complex, multi-step procedures requiring extended monitoring and specialized equipment setup.
• Hemostasis techniques such as argon plasma coagulation (APC) and clipping are lesion-specific based on morphological classification, meaning pre-procedure review of prior imaging/endoscopy reports helps the team anticipate which devices and accessories to have ready at the bedside.
• Gel immersion endoscopy is an emerging technique to improve visual field during vascular lesion treatment; nurses should be familiar with gel preparation, administration, and any unique irrigation or suction considerations this adds to the procedure.
• Endoscopic balloon dilation for Crohn's strictures and polypectomy techniques for hereditary polyposis syndromes are bowel-preserving alternatives to surgery—understanding this shift helps nurses provide more informed patient education about reduced surgical risk and preserved bowel length/function.

Clinical Relevance

This review highlights a meaningful shift in small bowel disease management that directly affects endoscopy unit workflow and nursing responsibilities. As BAE procedures increasingly combine diagnostic and therapeutic steps—such as identifying a vascular lesion and immediately applying APC or clips—nurses must be prepared for longer procedure times, more complex instrument trays, and heightened vigilance for procedural complications like perforation or bleeding, particularly during balloon dilation of fibrotic strictures. Familiarity with the rationale behind morphology-guided hemostasis decisions allows nursing staff to anticipate physician needs in real time, improving procedural efficiency and patient safety.

For patients with hereditary polyposis syndromes like Peutz-Jeghers syndrome or familial adenomatous polyposis, the shift toward endoscopic ischemic and cold snare polypectomy as a surveillance and treatment strategy has important implications for patient education and long-term care coordination. These patients often require repeated surveillance enteroscopies throughout their lives, and nurses play a critical role in explaining the purpose of prophylactic polypectomy (preventing intussusception and reducing malignancy risk), managing patient anxiety around recurrent procedures, and supporting continuity of care across multiple visits.

Similarly, the established role of endoscopic balloon dilation in Crohn's disease strictures reinforces the importance of nursing involvement in pre-procedure risk assessment and post-procedure monitoring. Because this approach aims to avoid surgical resection and the associated risk of short bowel syndrome, nurses should be equipped to discuss the benefits and limitations of bowel-preserving endoscopic therapy with patients who may be anxious about recurrent strictures or the possibility of eventual surgery. This also underscores the value of ongoing staff education on new devices and techniques as BAE technology continues to evolve.

Bottom Line

BAE is increasingly central to managing small bowel vascular lesions, hereditary polyposis syndromes, and Crohn's strictures through targeted, bowel-preserving therapies—GI nurses who understand the rationale behind lesion-specific techniques like APC, clipping, cold snare polypectomy, and balloon dilation will be better equipped to support safe, efficient procedures and deliver informed patient education that reinforces the goal of avoiding surgery and preserving quality of life.