Dr AvinashTank, is a super-specialist (MCh) Laparoscopic Gastro-intestinal Surgeon,

Enteroscopy

Amazing Facts about Enteroscopy

  • Milestone in Total Enteroscopy: Ropeway and Sonde Method (1971)
The first successful total enteroscopy was reported in 1971 using a ropeway and a sonde method. The sonde type consisted of a 5-mm forward-viewing fibroscope that can be passed transnasally and migrates distally to the stomach. The procedure was uncomfortable, painful, lasted 6–8 h and had limited insertion and diagnostic yield.  (Source)
  • Advancement with Capsule Endoscopy (2001)
Capsule endoscopy was first reported in 2001 opening up the small bowel for diagnostic approaches, but while it was useful for diagnosis it could not be used for therapeutic interventions. (Source) 
  • Breakthrough Technique: Double-Balloon Enteroscopy (2001)
The introduction of double-balloon enteroscopy in 2001 enabled endoscopic scrutiny of the entire small bowel with intervention capabilities and remains the most studied and established deep enteroscopy technique to date. (Source) 
  • PowerSpiral Enteroscopy: A New Frontier in Deep Enteroscopy (2015)
In 2015, clinical evaluation of the first motorized version of the Spiral Enteroscopy System started with the first human case of PowerSpiral Enteroscopy (PSE, Olympus Medical Systems Corporation, Tokyo, Japan). (Source) 

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

Untreated small bowel diseases can lead to various complications, which may vary depending on the specific condition. Here are some potential complications that can arise from 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

The 34th president of the United States and Army general credited for planning and executing D-Day during World War II had surgery while in office in 1956 to remove a section of his small intestine because of a blockage caused by his Crohn’s symptoms. (Source)

Dynamo

Illusionist Steven Frayne, better known as Dynamo, learned to do magic tricks as a boy to keep from being bullied. He’s had Crohn’s since his teens and had a portion of his stomach removed at 17. (Source)

Shamita Shetty

The Mohabbatein actor Shamita Shetty, currently appearing in Bigg Boss 15 also suffers from Inflammatory Bowel Disease. She even had to leave the show temporarily owing to her condition. (Source)

What is Enteroscopy

Enteroscopy is a specialized endoscopic procedure that allows healthcare professionals to visualize and examine the small intestine. This minimally invasive technique has revolutionized the diagnosis and treatment of various gastrointestinal conditions. In India, enteroscopy is gaining prominence as a valuable tool in the management of small bowel disorders. This article provides a comprehensive overview of enteroscopy, including its indications, procedure, benefits, limitations, and its role in promoting gastrointestinal health.

Procedure

Enteroscopy involves the insertion of a long, flexible tube with a camera and light source, known as an enteroscope, into the small intestine. There are two main types of enteroscopy: push enteroscopy and balloon-assisted enteroscopy.
  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

Enteroscopy is recommended in the following situations:
  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

Preparing for enteroscopy involves several important steps to ensure accurate and successful results. Here are some general guidelines to follow when preparing 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.
It is important to closely follow the specific instructions provided by your healthcare team for enteroscopy preparation, as these may vary depending on the individual case and the specific type of enteroscopy being performed. By adequately preparing for the procedure, you can help ensure accurate results and a smooth experience. If you have any questions or concerns about the preparation process, do not hesitate to contact your healthcare provider for clarification.

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

After an enteroscopy procedure, it is important to take certain steps to ensure a smooth recovery and minimize any potential complications. Here are some general guidelines on what to do after an 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.
Remember to reach out to your healthcare provider if you have any questions, concerns, or experience any unexpected symptoms or complications following the enteroscopy. They are best equipped to guide you through the post-procedure period and address any specific needs or issues related to your individual case.

80 years old, heart patient. Nevertheless, a ruptured gall bladder was successfully treated with binoculars.

Celebrities who have the Small Bowel Disease

Dwight D. Eisenhower

The 34th president of the United States and Army general credited for planning and executing D-Day during World War II had surgery while in office in 1956 to remove a section of his small intestine because of a blockage caused by his Crohn’s symptoms. (Source)

Dynamo

Illusionist Steven Frayne, better known as Dynamo, learned to do magic tricks as a boy to keep from being bullied. He’s had Crohn’s since his teens and had a portion of his stomach removed at 17. (Source)

Shamita Shetty

The Mohabbatein actor Shamita Shetty, currently appearing in Bigg Boss 15 also suffers from Inflammatory Bowel Disease. She even had to leave the show temporarily owing to her condition.

Amazing Facts about Enteroscopy

The first successful total enteroscopy was reported in 1971 using a ropeway and a sonde method. The sonde type consisted of a 5-mm forward-viewing fibroscope that can be passed transnasally and migrates distally to the stomach. The procedure was uncomfortable, painful, lasted 6–8 h and had limited insertion and diagnostic yield.  (Source)

Capsule endoscopy was first reported in 2001 opening up the small bowel for diagnostic approaches, but while it was useful for diagnosis it could not be used for therapeutic interventions. (Source

The introduction of double-balloon enteroscopy in 2001 enabled endoscopic scrutiny of the entire small bowel with intervention capabilities and remains the most studied and established deep enteroscopy technique to date. (Source

In 2015, clinical evaluation of the first motorized version of the Spiral Enteroscopy System started with the first human case of PowerSpiral Enteroscopy (PSE, Olympus Medical Systems Corporation, Tokyo, Japan). (Source

4 Reasons for Early Treatment of Small Bowel Diseases

Small bowel diseases, if left untreated, can lead to various complications. These may include intestinal blockages, malabsorption of nutrients, bleeding, perforation, and infections. 

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

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.

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

Untreated small bowel diseases can lead to various complications, which may vary depending on the specific condition. Here are some potential complications that can arise from untreated small bowel diseases:

What is Enteroscopy

Enteroscopy is a specialized endoscopic procedure that allows healthcare professionals to visualize and examine the small intestine. This minimally invasive technique has revolutionized the diagnosis and treatment of various gastrointestinal conditions. In India, enteroscopy is gaining prominence as a valuable tool in the management of small bowel disorders. This article provides a comprehensive overview of enteroscopy, including its indications, procedure, benefits, limitations, and its role in promoting gastrointestinal health.

Procedure

Enteroscopy involves the insertion of a long, flexible tube with a camera and light source, known as an enteroscope, into the small intestine. There are two main types of enteroscopy: push enteroscopy and balloon-assisted enteroscopy.

  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?

Enteroscopy is recommended in the following situations:

  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?

Preparing for enteroscopy involves several important steps to ensure accurate and successful results. Here are some general guidelines to follow when preparing 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.

Remember, these are general guidelines, and it is important to follow the specific instructions provided by your doctor. If you have any questions or concerns during the recovery period, do not hesitate to reach out to your healthcare provider for further guidance.

Benefits of Enteroscopy

Risks of Enteroscopy

What to do after Enteroscopy?

After an enteroscopy procedure, it is important to take certain steps to ensure a smooth recovery and minimize any potential complications. Here are some general guidelines on what to do after an enteroscopy:

Remember to reach out to your healthcare provider if you have any questions, concerns, or experience any unexpected symptoms or complications following the enteroscopy. They are best equipped to guide you through the post-procedure period and address any specific needs or issues related to your individual case.

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