What is Enteroscopy?

An enteroscopy is a procedure that examines and treats issues associated with the small intestine. There are over 20 feet of intestine here, and each inch is just one inch wide, making it difficult to reach.

To gain access deep into the small intestine, gastroenterologists may use video capsule endoscopy, double balloon enteroscopy, single balloon enteroscopy, and spiral enteroscopy. Deep enteroscopy consists of spiral enteroscopy and balloon enteroscopy.

Types of Enteroscopy 

Enteroscopy is a medical procedure designed to visualize and examine the small intestine, a part of the digestive system that is challenging to access with traditional endoscopic methods. There are two main types of enteroscopy: push enteroscopy and balloon-assisted enteroscopy.

1. Push Enteroscopy:
Push enteroscopy is a diagnostic procedure that involves advancing a conventional endoscope through the upper gastrointestinal tract to visualize the upper portion of the small intestine, known as the jejunum. This method is suitable for investigating abnormalities, such as bleeding or tumours, in the upper part of the small intestine. The endoscope is typically advanced manually, allowing for direct visualization of the intestinal lining and the collection of tissue samples for biopsy if necessary. While push enteroscopy provides valuable insights into the upper small intestine, its reach is limited compared to other enteroscopy techniques.

2. Balloon-Assisted Enteroscopy (BAE):
Balloon-assisted enteroscopy is a more advanced and versatile technique for examining the entire small intestine. There are two main types of BAE: single-balloon enteroscopy (SBE) and double-balloon enteroscopy (DBE). Both methods involve the use of specialized endoscopes equipped with inflatable balloons to facilitate deeper insertion into the small intestine.

●    Single-Balloon Enteroscopy (SBE):
In SBE, a single balloon attached to the endoscope is inflated and deflated to anchor and propel the endoscope, allowing for controlled advancement into the small intestine. This method is particularly useful for accessing the jejunum and ileum, enabling thorough examination and intervention.

●    Double-Balloon Enteroscopy (DBE):
DBE employs two balloons – one on the endoscope and another on an overture. The dual balloon system provides enhanced control and stability during the procedure. The overtube can be advanced over the endoscope, allowing for deeper insertion into the small intestine. DBE is known for its high success rate in reaching the entire small bowel and is particularly effective for both diagnostic and therapeutic purposes.

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Risks of Enteroscopy

While enteroscopy is generally considered a safe and minimally invasive procedure, it does carry some inherent risks. Common risks associated with enteroscopy include:

•  Bleeding: The insertion and manipulation of the endoscope within the small intestine can potentially cause bleeding. This risk may be higher in individuals with pre-existing bleeding disorders.
•  Perforation: There is a slight risk of unintentional perforation or puncturing of the intestinal wall during the enteroscopy procedure. This risk is relatively low but can lead to complications requiring further medical intervention.
•  Infection: Although rare, there is a minimal risk of infection, particularly if the endoscope introduces bacteria into the gastrointestinal tract. Sterile techniques are employed to mitigate this risk, but it is not eliminated.
•   Adverse Reaction to Sedation: The use of sedatives during enteroscopy poses a risk of adverse reactions, such as respiratory or cardiovascular complications. Patients are typically closely monitored to address any potential issues promptly.
•   Allergic Reactions: Some individuals may experience allergic reactions to medications, contrast agents, or materials used during the procedure. This risk is generally low but is taken into consideration, especially in patients with known allergies.
• Post-procedure Discomfort: After the enteroscopy, patients may experience mild abdominal discomfort, bloating, or nausea. These symptoms are usually temporary but should be reported to the healthcare provider if they persist or worsen.

Purpose of Enteroscopy

Enteroscopy serves several purposes in the field of gastroenterology, providing valuable diagnostic and therapeutic capabilities specifically tailored for the small intestine. The primary purposes of enteroscopy include:

•  Visualizing the Small Intestine: The small intestine is challenging to access with traditional endoscopic procedures due to its length and location. Enteroscopy allows direct visualization of the small bowel, including the jejunum and ileum, enabling the identification of abnormalities, lesions, and other gastrointestinal conditions.
• Diagnosing Gastrointestinal Disorders: Enteroscopy is a crucial tool for diagnosing various gastrointestinal disorders affecting the small intestine, such as Crohn's disease, small bowel tumours, vascular malformations, ulcers, and bleeding disorders. The procedure facilitates the collection of tissue samples (biopsies) for histological analysis, aiding in accurate diagnosis.
•  Evaluating Obscure Gastrointestinal Bleeding: Enteroscopy is particularly valuable in cases of obscure gastrointestinal bleeding where the source of bleeding is challenging to identify. By directly examining the small bowel, gastroenterologists can locate and treat bleeding lesions or abnormalities.
•  Removing Polyps and Lesions: Therapeutic enteroscopy allows for the removal of polyps, tumours, or abnormal tissue identified during the procedure. This can be crucial for both diagnostic and therapeutic purposes, as well as preventing potential complications such as bleeding.
• Treating Small Bowel Disorders: In addition to diagnosis, enteroscopy enables therapeutic interventions within the small intestine. This includes the placement of stents to alleviate obstructions, dilating strictures, and managing conditions such as small bowel Crohn's disease.
•  Localizing Tumors and Abnormalities: Enteroscopy helps in precisely localizing tumours, vascular malformations, or other abnormalities within the small bowel. This information is essential for planning subsequent treatment strategies.
•   Monitoring Treatment Response: For patients with known small bowel conditions or those undergoing treatment, enteroscopy allows healthcare providers to monitor the effectiveness of therapeutic interventions and make informed adjustments to the treatment plan as needed.
•  Exploring Anatomical Abnormalities: Some individuals may have congenital or acquired anatomical abnormalities in the small intestine. Enteroscopy can be instrumental in exploring the anatomy of the small bowel, aiding in the understanding and management of such conditions.

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Procedure of Enteroscopy

Enteroscopy is a medical procedure designed to visualize and assess the small intestine, which is challenging to reach with traditional endoscopic methods. The procedure involves:

1.Preparation:
Before the enteroscopy, patients may be instructed to fast for a specific period to ensure a clear view of the small intestine. Additionally, they may receive sedation to enhance comfort during the procedure.

2. Insertion of the Endoscope:
The gastroenterologist inserts a flexible, thin tube called an endoscope through the mouth or anus, depending on the type of enteroscopy. The endoscope is equipped with a light source and a camera that transmits images to a monitor.

3. Advancement into the Small Intestine:
The endoscope is carefully guided through the upper or lower gastrointestinal tract, reaching the small intestine. In balloon-assisted enteroscopy, inflatable balloons on the endoscope or overtube assist in advancing and stabilizing the scope.

4.  Visualization and Biopsy:
As the endoscope progresses, the gastroenterologist visually examines the lining of the small intestine. Tissue samples (biopsies) may be collected for further analysis if abnormalities are detected.

5.Treatment Interventions:
If abnormalities like polyps or lesions are identified, therapeutic interventions may be performed during the enteroscopy. This can include the removal of abnormal tissue, dilation of strictures, or the placement of stents.

6.Monitoring and Documentation:
The entire procedure is monitored on a video screen, allowing the healthcare provider to document findings and assess the condition of the small intestine. Real-time imaging helps guide the procedure and address any issues that arise.

7.Post-Procedure Care:
After the enteroscopy, patients are monitored as they recover from sedation. They may experience mild discomfort, bloating, or gas, but these effects are usually temporary. Any biopsied samples are sent to the laboratory for analysis.

8. Follow-Up Discussion:
The gastroenterologist discusses the findings with the patient and, if necessary, provides recommendations for further treatment or follow-up care. This may include additional tests or procedures based on the results of the enteroscopy.

Conclusion

In conclusion, enteroscopy stands out as a pivotal medical procedure at Khandaka Hospital, playing a crucial role in diagnosing and treating small intestine-related disorders. 

This advanced endoscopic technique, offered exclusively at our hospiital, empowers our healthcare professionals to directly visualize the intricate and challenging-to-reach small bowel. 

The procedure at Khandaka involves meticulous preparation, the insertion of a specialized endoscope, and skilful advancement through the gastrointestinal tract. This facilitates a comprehensive examination, biopsy collection, and targeted therapeutic interventions as needed, all performed with the utmost precision.

Khandaka Hospital takes pride in the exceptional value of enteroscopy, particularly in managing cases of obscure gastrointestinal bleeding, obscure small bowel diseases, and the identification of tumours, polyps, or other abnormalities. 

Our hospital's commitment to dual diagnostic and therapeutic capabilities ensures a more accurate understanding of small intestine conditions, allowing for prompt and targeted interventions that significantly enhance patient outcomes.

As the leading healthcare provider in the region, Khandaka Hospital's use of enteroscopy reflects our dedication to offering state-of-the-art medical services. This minimally invasive yet powerful tool not only improves the precision of medical diagnoses and treatments but also underscores our commitment to fostering a proactive approach to gastrointestinal health.