Enteroscopy

Amazing Facts about Enteroscopy

• Milestone in Total Enteroscopy: Ropeway and Sonde Method (1971)

• Advancement with Capsule Endoscopy (2001)

• Breakthrough Technique: Double-Balloon Enteroscopy (2001)

• PowerSpiral Enteroscopy: A New Frontier in Deep Enteroscopy (2015)

4 Reasons for Early Treatment of  Small Bowel Diseases

1. Prevention of complications– Small bowel diseases, if left untreated, can lead to various complications. These may include intestinal blockages, malabsorption of nutrients, bleeding, perforation, and infections. 
2. Improved quality of life– Symptoms such as chronic abdominal pain, diarrhea, weight loss, and nutritional deficiencies can affect daily activities, work, and overall well-being. Early treatment can alleviate symptoms and improve the quality of life
3. Disease progression prevention– Many small bowel diseases have a progressive nature, meaning they worsen over time if left untreated. Conditions such as Crohn’s disease, celiac disease, small bowel tumors, and inflammatory bowel disease can lead to irreversible damage to the small bowel if not addressed promptly.
4. Early diagnosis of underlying conditions– Small bowel diseases may sometimes be a manifestation of underlying systemic conditions or disorders affecting other parts of the body. For example, celiac disease is associated with autoimmune disorders, and small bowel tumors can be a sign of malignancies elsewhere in the body. 

Complications of Untreated Small Bowel Diseases

• Malnutrition
• Intestinal Obstruction
• Fistulas (abnormal connections or tunnels that form between different parts of the intestine or between the intestine and other organs)
• Bowel Perforation
• Small Bowel Bleeding
• Small Bowel Cancer

Celebrities who have the Small Bowel Disease

Dwight D. Eisenhower

Dynamo

Shamita Shetty

What is Enteroscopy

Procedure

1. Push Enteroscopy: In this procedure, the enteroscope is advanced through the mouth or anus to reach the desired section of the small intestine. It allows for direct visualization and biopsy of the small bowel.
2. Balloon-Assisted Enteroscopy: This technique utilizes an enteroscope with an inflatable balloon at its tip. The balloon is inflated to anchor the small intestine, enabling deeper insertion and improved visualization. It allows for both diagnostic and therapeutic interventions.

Who needs Enteroscopy

1. Obscure Gastrointestinal Bleeding: Enteroscopy is highly effective in diagnosing the source of obscure gastrointestinal bleeding that cannot be identified using other diagnostic methods.
2. Evaluation of Small Bowel Diseases: It is useful in assessing and diagnosing conditions such as Crohn’s disease, celiac disease, small bowel tumors, ulcers, and malabsorption syndromes affecting the small intestine.
3. Polyp Detection and Removal: Enteroscopy allows for the detection and removal of polyps, lesions, or abnormal growths in the small intestine.
4. Endoscopic Therapy: It enables therapeutic interventions such as the removal of small bowel polyps, treatment of bleeding ulcers, stricture dilation, and the placement of stents or feeding tubes.
5. Surveillance of Small Bowel Disorders: Enteroscopy plays a crucial role in the long-term monitoring of patients with small bowel diseases, evaluating treatment response, and detecting disease recurrence.

How to prepare for Enteroscopy

• Consultation: Schedule a consultation with your healthcare provider to discuss the procedure and any specific instructions or preparations they may have for you.
• Medication Review: Inform your doctor about all the medications you are currently taking, including prescription medications, over-the-counter drugs, and supplements. They may advise you to temporarily stop certain medications, particularly blood-thinning medications or nonsteroidal anti-inflammatory drugs (NSAIDs) that can increase the risk of bleeding.
• Fasting: Your doctor will likely instruct you to fast for a certain period before the enteroscopy procedure. This means refraining from eating or drinking anything for a specific amount of time prior to the procedure. This is typically done to ensure that your small bowel is empty, allowing for better visualization during the examination. Follow your doctor’s instructions regarding fasting duration.
• Bowel Preparation: Your doctor may prescribe a bowel preparation regimen to cleanse the small bowel before the enteroscopy. This may involve taking oral laxatives, drinking a special solution, or using enemas to help clear the bowel. Follow the instructions provided by your healthcare team carefully to ensure an effective bowel preparation.
• Hydration: While fasting, it is important to stay hydrated. Your doctor will provide instructions on how much clear fluids you can consume during the fasting period. Clear liquids may include water, clear broth, tea, and coffee without creamer.
• Medication Adjustments: If you have specific medical conditions such as diabetes, hypertension, or heart conditions, consult your doctor regarding any necessary adjustments to your medication regimen before the procedure.
• Transportation: Arrange for someone to accompany you to the enteroscopy appointment and drive you home afterward. The sedation used during the procedure can impair your ability to drive and make decisions.
• Inform your Doctor: Notify your doctor of any changes in your health, such as the development of a fever, respiratory infection, or any other illness before the scheduled enteroscopy. These conditions may require rescheduling the procedure.

Benefits of Enteroscopy

1. Precise Visualization of the Small Intestine: Enteroscopy provides direct visualization of the small intestine, allowing for the identification and diagnosis of small bowel disorders that may be missed by other diagnostic methods.
2. Enhanced Diagnostic Accuracy: It enables targeted biopsies, sample collection, and precise localization of lesions, facilitating accurate diagnosis and treatment planning.
3. Therapeutic Interventions: Enteroscopy allows for various therapeutic procedures, such as polyp removal, stricture dilation, control of bleeding ulcers, and placement of stents or feeding tubes, reducing the need for open surgery.
4. Minimally Invasive: Enteroscopy is a minimally invasive procedure that significantly reduces patient discomfort, hospital stay, and recovery time compared to traditional surgical options.
5. Early Detection and Treatment: By facilitating early detection and intervention, enteroscopy improves patient outcomes, preventing complications and providing timely treatment for small bowel disorders.

Risks of Enteroscopy

1. Technical Complexity: Enteroscopy is a technically demanding procedure that requires specialized training and expertise to ensure successful outcomes.
2. Limited Accessibility: The reach of enteroscopy may be limited to certain areas of the small intestine, particularly in cases of long-segment diseases or strictures that prevent complete passage of the enteroscope.
3. Risk of Complications: Although rare, complications such as bleeding, perforation, or infection may occur during or after the procedure.
4. Patient Tolerance: Some patients may experience discomfort or difficulty tolerating the procedure, particularly during prolonged examinations or therapeutic interventions.
5. Cost and Availability: Enteroscopy may be relatively costly, and its availability may vary across different healthcare settings, limiting access for some patients.

What to do after Enteroscopy

• Recovery Area: After the procedure, you will be taken to a recovery area where healthcare professionals will monitor your vital signs and observe you as you wake up from the sedation. It is normal to feel drowsy or groggy immediately after the procedure.
• Rest and Observation: Take it easy and allow yourself time to recover. Rest for the remainder of the day and avoid any strenuous activities. It is common to experience some bloating, gas, or mild abdominal discomfort after the procedure. These symptoms usually subside within a few hours to a day.
• Post-Procedure Instructions: Your healthcare provider will provide you with specific post-procedure instructions. Follow these instructions carefully to ensure proper healing and recovery. This may include information on diet, medication, and any activity restrictions.
• Diet and Hydration: Your doctor will advise you on when you can resume eating and drinking after the enteroscopy. In most cases, you can start with clear liquids and gradually progress to a regular diet as tolerated. Stay well-hydrated by drinking plenty of fluids, unless otherwise instructed by your doctor.
• Medication: Resume taking your regular medications unless instructed otherwise by your healthcare provider. If any changes to your medication regimen are necessary, your doctor will provide specific instructions.
• Side Effects and Complications: Be aware of any potential side effects or complications that may arise after the procedure. Contact your healthcare provider if you experience severe abdominal pain, persistent bleeding, fever, or any other concerning symptoms.
• Follow-Up Appointment: Schedule a follow-up appointment with your doctor to review the results of the enteroscopy and discuss any further management or treatment plans if needed.
• Transportation: Arrange for someone to drive you home after the procedure, as the sedation used during the enteroscopy can impair your judgment and reflexes. Do not operate machinery or drive a vehicle for at least 24 hours following the procedure.