Enteroscopy
Encyclopedia
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. <1-4>
References:
1. Upchurch B, Vargo J.,Small Bowel Enteroscopy. Reviews in Gastroenterological Disorders. Summer 2008;8(3):169-177.
2. Upchurch B, Vargo J., Single Balloon Enteroscopy. Gastrointestinal Endoscopy Clinics of North America. July 2009;19(3) 335-347.
3. The Clinical Utility of Single Balloon Enteroscopy: A Single Center Experience of 172 procedures. Upchurch, BR; Vargo, JJ; Sanaka, MR; Alhaji, M. Gastrointestinal Endoscopy. 2010 April 19.
4. Spiral Enteroscopy and Push Enteroscopy. Akerman PA,Cantero D. Gastrointestinal endoscopy clinics of North America 1 July 2009 (volume 19 issue 3 Pages 357-369)
Small intestine
The small intestine is the part of the gastrointestinal tract following the stomach and followed by the large intestine, and is where much of the digestion and absorption of food takes place. In invertebrates such as worms, the terms "gastrointestinal tract" and "large intestine" are often used to...
.
- video chip endoscopeEndoscopyEndoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope , an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ...
- Double-balloon enteroscopyDouble-balloon enteroscopyDouble-balloon enteroscopy, also known as push-and-pull enteroscopy is an endoscopic technique for visualization of the small bowel. It was developed by Hironori Yamamoto in 2001...
- Single-balloon enteroscopy
- Spiral enteroscopy
- Double-balloon enteroscopy
- wireless endoscopy system
- Capsule endoscopyCapsule endoscopyCapsule endoscopy is a way to record images of the digestive tract for use in medicine. The capsule is the size and shape of a pill and contains a tiny camera. After a patient swallows the capsule, it takes pictures of the inside of the gastrointestinal tract...
- Capsule endoscopy
Visualization of the small bowel has posed a challenge to gastroenterologists
Gastroenterology
Gastroenterology is the branch of medicine whereby the digestive system and its disorders are studied. The name is a combination of three Ancient Greek words gaster , enteron , and logos...
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
Esophagogastroduodenoscopy
For other expansions of the initialism "OGD", see the disambiguation page.In medicine , esophagogastroduodenoscopy is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum...
can generally visualize the proximal and distal duodenum
Duodenum
The duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms anterior intestine or proximal intestine may be used instead of 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
Jejunum
The jejunum is the middle section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms middle intestine or mid-gut may be used instead of jejunum.The jejunum lies between the duodenum...
. 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
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
, 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
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
. 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. <1-4>
References:
1. Upchurch B, Vargo J.,Small Bowel Enteroscopy. Reviews in Gastroenterological Disorders. Summer 2008;8(3):169-177.
2. Upchurch B, Vargo J., Single Balloon Enteroscopy. Gastrointestinal Endoscopy Clinics of North America. July 2009;19(3) 335-347.
3. The Clinical Utility of Single Balloon Enteroscopy: A Single Center Experience of 172 procedures. Upchurch, BR; Vargo, JJ; Sanaka, MR; Alhaji, M. Gastrointestinal Endoscopy. 2010 April 19.
4. Spiral Enteroscopy and Push Enteroscopy. Akerman PA,Cantero D. Gastrointestinal endoscopy clinics of North America 1 July 2009 (volume 19 issue 3 Pages 357-369)