Enteroscopy is a visual examination of the upper intestinal tract including stomach and esophagus using a lighted, flexible tube camera or video endoscope. The upper gastrointestinal tract begins with the mouth and continues with the esophagus or food pipe which carries food and saliva to the stomach. The stomach secretes a potent acid and churns food into small particles and partially digest the food. The food then enters the duodenum, or small bowel, where bile from the liver and digestive juices from the pancreas mix with it to help the digestive process.
EQUIPMENT
The flexible endoscope is a remarkable piece of equipment that can be directed and moved around the many bends in the gastrointestinal tract. This video endoscope has a tiny, optically sensitive computer chip at the end which transfers signals to a large video screen. An open channel in these scopes allows other instruments to be passed through in order to take tissue samples, remove polyps and perform other exams.
REASONS FOR THE EXAM
Abdominal pains, unexplained vomiting
Ulcers-ulcers are sores in the lining of esophagus, stomach, or duodenum and upper part of small bowel
Unexpalined Bleeding-bleeding can sometimes not dignosed by just upper endocopy.
Crohn’s disease-thid chronic inflammatory condition can occur in upper part of small bowel.
To treat or cofirm certain conditions diagnosed during capsule endoscopy
Small bowel tumors
PREPARATION
It is important not to eat or drink anything for at least eight hours before performing the enteroscopy procedure. The physician instructs the patient about the use of regular medications, including blood thinners, before the exam.
THE PROCEDURE
Push enteroscopy procedure is usually performed on an outpatient basis. Intravenous anesthesia is usually given which makes the patient unconscious for a brief period. The endoscope is then gently inserted into the upper esophagus. The patient can breath easily throughout the exam. Other instruments can be passed through the endoscope to perform additional procedures if necessary. For example, a biopsy can be done in which a small tissue specimen is obtained for microscopic analysis. A polyp or tumor can be removed using a thin wire snare and electrocautery (electrical heat). A bleeding can be controlled also. The exam takes from 5 to 15 minutes, after which the patient is taken to the recovery area. There is no pain with the procedure and patients seldom remember much about it.
RESULTS
After the exam, the physician will explain the results to the patient and family. Biopsy result will be available in few days.
BENEFITS
A push enteroscopy is performed primarily to identify and/or correct a problem in the upper intestinal tract. This means the test enables a diagnosis to be made upon which specific treatment can be given. If a bleeding site is identified, treatment can stop the bleeding, or if a polyp is found, it can be removed without a major operation. Other treatments can be given through the endoscope when necessary. The enteroscopy cost is affordable.
ALTERNATIVE TESTING
Alternative tests to push enteroscopy is small bowel series and CT enterography. Study of the stools, blood and stomach juice can provide indirect information about a gastrointestinal condition. These exams, however, do not allow for a direct viewing of the esophagus, stomach and duodenum, removing of polyps or taking of biopsies.
SIDE EFFECTS AND RISKS
A temporary, mild throat irritation and very rarely aspiration pneumonia occurs after the exam. Serious risks with enteroscopy, however, are very uncommon. One such risk is excessive bleeding, especially with removal of a large polyp. In extremely rare instances, a perforation, or tear, in the esophagus or stomach wall can occur. These complications may require hospitalization and, rarely, surgery. Quite uncommonly, a diagnostic error or oversight may occur. Due to the mild sedation, the patient should not drive or operate machinery following the exam. For this reason, someone else should be available to drive the patient home.
SUMMARY
Push enteroscopy is a simple outpatient exam that is often performed with the patient lightly sedated. The procedure provides significant information upon which specific treatment can be given. In certain cases, therapy can be administered directly through the endoscope. Serious complications rarely occur from push enteroscopy. The physician can answer any question the patient has.
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