Enteroscopy

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Enteroscopy is the procedure of using an enteroscope for the direct visualization of small bowel.

Visualization of the small bowel has posed a challenge to gastroenterologists due to the difficulty of physically reaching more distal regions of the small bowel anatomically. As the small bowel can often be a source of pathology, endoscopy of the small bowel can be a useful diagnostic and therapeutic technique.[1]

Traditional gastroscopes can generally visualize the proximal and distal duodenum in the hands of experienced endoscopists but are limited due to the length of the instrument. Pediatric colonoscopes or sometimes dedicated enteroscopes which are much longer than standard gastroscopes can visualize the proximal jejunum. This technique is referred to as push enteroscopy. Due to the length of the small bowel, averaging 4–6 meters in the adult, push enteroscopy is still not effective to adequately visualize large portions of the small intestine.[1][2]

Wireless capsule endoscopy has proven to be the endoscopic investigation of choice for visualization of the entire small bowel. An 11 x 26 mm pill sized video camera is swallowed by the patient and approximately 8 hours of video is transmitted wirelessly to a receiver worn by the patient. The procedure is painless, well accepted by patients and offers a very high accuracy. It is limited by the inability to obtain biopsies, and is therefore considered a purely diagnostic tool.[1][2]

Newer techniques, including single and double-balloon endoscopy have been developed to overcome some of these issues, but are limited by the length of the procedure, and the need for deep sedation or general anesthesia. Spiral enteroscopy is a novel technique that utilizes an overtube with raised spirals affixed on the enteroscope that is rotated to advance the enteroscope deep into the small bowel. Each of these 3 enteroscopy platforms offers similar accuracy and effectiveness but do not have widespread availability.[1][2] [3] [4]

References[edit]

  1. ^ a b c d Upchurch BR, Vargo JJ (2008). "Small bowel enteroscopy". Rev Gastroenterol Disord 8 (3): 169–77. PMID 18957924. 
  2. ^ a b c Upchurch BR, Vargo JJ (July 2009). "Single-balloon enteroscopy". Gastrointest. Endosc. Clin. N. Am. 19 (3): 335–47. doi:10.1016/j.giec.2009.04.010. PMID 19647643. 
  3. ^ Akerman PA, Cantero D (July 2009). "Spiral enteroscopy and push enteroscopy". Gastrointest. Endosc. Clin. N. Am. 19 (3): 357–69. doi:10.1016/j.giec.2009.04.001. PMID 19647645. 
  4. ^ Upchurch BR, Sanaka MR, Lopez AR, Vargo JJ (June 2010). "The clinical utility of single-balloon enteroscopy: a single-center experience of 172 procedures". Gastrointest. Endosc. 71 (7): 1218–23. doi:10.1016/j.gie.2010.01.012. PMID 20409544.