The small bowel is the longest and deepest part of the digestive tract and measures about 6 meters in length. Hence, it cannot be reached with normal endoscopic techniques. Recent technological breakthroughs now enable endoscopist to visualize the small bowel and perform endoscopic interventions. There are 2 methods to access the small bowel: Capsule Endoscopy, and Deep Enteroscopy. The doctor should be able to discuss with the patient which method is more suitable for the specific clinical situation.
Capsule Endoscopy utilizes a pill-sized camera with its own light source to visualize the small bowel as it travels through it. The capsule is the size of a large pill, and be easily swallowed in the doctor’s office. Once it enters the digestive system, it will capture images of the digestive system and transmit them wirelessly to a data recorder worn by the patient. The patient will not feel the capsule and can proceed with his daily activities. The capsule will not be digested or absorbed, and will eventually pass out through a bowel movement. The capsule is single-use and lasts up to 16 hours, which is usually sufficient to visualize the entire small bowel. The data in the recorder is then downloaded to a computer for the doctor to view.
Deep enteroscopy is a technique that allows the doctor to advance a long endoscope into the small bowel for diagnostic and therapeutic purposes. The technique utilizes a device such as a balloon or spiral overtube to enable to doctor to advance through the long and mobile small bowel. The endoscope can be passed through the mouth (antegrade enteroscopy) to access the upper small bowel, or through the anus (retrograde enteroscopy) to access the lower small bowel. Specialized long accessories enable the doctor to perform endoscopic interventions through the long endoscope These include tissue biopsy, polyp resection, tissue ablation, dilation of strictures and removal of foreign objects.
Small bowel endoscopy is most commonly used for the following cases:
- Evaluation and sampling of abnormal areas in the small bowel detected on other scans.
- Evaluation and treatment of suspected bleeding from the small bowel.
- Evaluation and treatment of unexplained iron deficiency anemia.
- Evaluation of unexplained abdominal pain.
- Evaluation and resection of polyps in patients with polyposis syndrome.
- Treatment of small bowel strictures.
- Monitoring of small bowel disorders.
You should fast for at least 6 hours prior to your small bowel enteroscopy. Longer fasting may be needed if your doctor suspects that your stomach is not emptying properly. You may drink clear fluid up to 2 hours before the procedure but milk is not allowed during the fasting.
In general, most medication should be continued before the enteroscopy with the exception of diabetes medication and blood thinners. Diabetic medication should be omitted during the fasting. You should check with your doctor if your blood thinner needs to be discontinued prior to the procedure.
You will need bowel preparation for some of the examinations. Please check with your doctor.
As you will be given medication to make you sleepy, you must not drive, work or make any important decision after the procedure. Medical Certificate will be issued if needed and you should rest at home for the rest of the day.
Before the enteroscopy
A nurse will conduct final checks, and bring you into the procedure room. An intravenous line will be inserted.
During the enteroscopy
A throat spray will be administered to lessen the discomfort of the procedure.
You will be lying on your left, with your legs curled up and a plastic bite will be placed between your teeth to protect your teeth.
Sedation will then be given. After you have fallen asleep, the procedure will begin. You will likely not remember any of the procedure. You will be breathing on your own and monitored closely during the procedure.
You will wake up gradually after the procedure is done. All the medication used for sedation have a duration of action of a few minutes.
After the enteroscopy
You will be cared for in a recovery area or room. The nurses will give you food and drink when they assessed that you are ready. You should arrange for a family member to take discharge instruction and take you home. You should only resume working and driving the following day.
Sometimes, you may have a mild sore throat, bloating and cramping. This normally goes away after 24 hours.
Small bowel endoscopy is an advanced endoscopic technique. Additional training after specialization is required to perform both capsule endoscopy and deep enteroscopy properly. In particular, deep enteroscopy is required a period of supervised training and adequate case exposure as the technique is rather different from general endoscopy and much more difficult to perform. When performed properly, deep enteroscopy is as safe as general endoscopy. Hence, it is important to ensure that the doctor performing the procedure has the appropriate expertise for the case. The doctor should welcome questions regarding their training, credentials, and experience. Simple questions such as the following are useful:
- Which public institution where you formally certified to do small bowel endoscopy independently?
- How many cases have you performed?
- What is your total small bowel completion rate?
- How will you detect complications and how have you managed these before?
- What type of deep enteroscopy treatments have you performed?
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