Enteroscopy is an endoscopic procedure for the diagnosis and treatment of diseases affecting small intestine, the part of the intestine which is beyond the reach of the standard upper GI endoscopy and colonoscopy. A flexible endoscope (enteroscopy) is inserted through the patient’s mouth (per oral or ante-grade enteroscopy) or anus (retro-grade enteroscopy) and almost whole of the small intestine can be reached.
The common indications for performing enteroscopy are a pain in the abdomen, obscure GI bleeding, diarrhoea and unexplained weight loss, where routine investigations including upper GI endoscopy and colonoscopy have failed to find the cause of symptoms. Enteroscopy with high definition imaging including narrow banding imaging is used to visualize lesions and take targeted biopsies in diseases like Crohn’s disease, small intestine polyps and tumours, lymphoma, celiac disease and other diseases affecting small intestine.
Enteroscopy is an effective therapeutic procedure used to treat diseases of the mall intestine. Enteroscopy can be used to dilate small bowel strictures, take out the foreign body, polypectomy (removal of polyps) and immediate control active bleeding from vascular lesions like angioectasias and dieulafoy’s lesions using argon plasma coagulation and hemoclip application and thus avoiding major abdominal surgeries.
Enteroscopy assisted ERCP is an advanced endoscopic procedure to treat diseases of the bile duct and pancreas. It is done in patients where standard ERCP is not feasible due to surgically altered anatomy like those patients who have previously undergone hepatobiliary, intestinal and bariatric surgery.
Patient preparation for enteroscopy is simple, the patient who is planned for retro-grade enteroscopy is advised to take laxative solution on the evening before and on the day of the procedure to clear the bowel, while the patient who is planned for ante-grade enteroscopy should have overnight fasting or minimum of 8 hours of nil by mouth.
Enteroscopy is a very safe procedure and associated with very low risk. Most of the procedures can be done as an out-patient procedure and the patient can expect to go home a few hours after the procedure. It is performed with conscious sedation (minimal anaesthesia), although some patients may require deep sedation also, depending upon the indication and therapeutic procedure being planned. Minor complications like irritation or pain at the injection site, allergic reaction to the anaesthetic drug used, mild pain abdomen after the procedure and minor bleeding at biopsy or polypectomy site can be managed easily. Although rare, one possible complication is a perforation, or tear through the wall of the bowel which may require abdominal surgery.