Enteroscopy

Using a special endoscope that is about two and a half times as long as a standard upper endoscope, enteroscopy allows a physician to look further into, or at the entire length of, the small bowel (which is up to 25 feet long). It is primarily used to find sources of intestinal bleeding, but can also be used to find lesions and determine causes for nutritional malabsorption.

In addition, enteroscopy can be used to treat bleeding lesions, dilate (stretch open) strictures, remove polyps or masses, biopsy abnormal tissue, and remove foreign objects. This procedure may follow a small bowel capsule study, which can locate problems that need local treatment.

Enteroscopy can be performed in an outpatient or inpatient setting and may require several hours, depending on the therapy required. It is often performed with general anesthesia although some patients may require only moderate sedation.

Fluoroscopy, or the use of X-ray, is frequently employed during the procedure. Most procedures are performed through the mouth, although doing so through the rectum may allow better access to lesions in the lower part of the small bowel.

How to Prepare for Enteroscopy

If the procedure will be done through the mouth, you should not eat or drink anything after midnight prior to the procedure.

If the procedure will be done through the rectum, you will need to undergo bowel prep similar to preparing for a colonoscopy. Your doctor will provide you with specific instructions.

Your doctor will let you know if or when you should adjust or stop any medications you take. Because you will be sedated, you will need someone to drive you home after the procedure.

Balloon-assisted Enteroscopy

At AG, our gastroenterologists use balloon-assisted enteroscopy. Double-balloon enteroscopy is a technique allowing gastroenterologists to perform therapeutic procedures in the small bowel without invasive surgery. The small bowel has been difficult to access until recently, and treatments to the area have traditionally been surgical. Now, several options to assess and treat the small bowel have emerged.

What to Expect

For double-balloon enteroscopy, the procedure involves the use of a special enteroscope, along with an overtube that is fitted with a balloon. You will be comfortably sedated on your left side while the enteroscope and overtube are inserted into the mouth, through the esophagus, and out the bottom of the stomach into the small bowel.

This procedure is known as push-and-pull enteroscopy because the balloon is inflated ahead of the scope and the small bowel is telescoped back over the overtube while the balloon holds the small bowel in place. The process is repeated over and over until the entire small bowel is visualized.

The procedure may also be performed with a single balloon, known as push enteroscopy.

The benefit of a procedure like this is that the physician can perform treatments without surgery, such as removing polyps, obtaining a biopsy of a tumor, placing a stent, dilating a stricture, or cauterizing an active bleed. Foreign bodies can even be removed this way. Should you end up needing surgery, the doctor can place a "tattoo" to easily locate the exact site.