What is Deep Enteroscopy?
Deep enteroscopy is an incisionless procedure whereby a long endoscope is inserted into the gastrointestinal tract. A common type is balloon-assisted enteroscopy, which makes use of small balloons to allow an endoscope to effectively travel through the small intestine, which is typically hard to reach. After the endoscope is inserted through the mouth (antegrade approach), the balloons are alternately inflated and deflated, allowing movement through the gastrointestinal tract.
On average, the small intestine is six metres long, making it difficult to reach using more-traditional endoscopy procedures. A deep enteroscopy works by “pleating” the intestine as the endoscope is threaded through it, which can be likened to pushing a rod through a curtain.
Deep enteroscopies are typically performed to treat small intestinal pathology that are difficult to access via other means or to diagnose unexplained gastrointestinal tract bleeding.
- Antegrade approach — introducing the endoscope via the mouth.
- Retrograde approach — introducing the endoscope via the anus.
Endoscopy vs Enteroscopy
The prefix “entero” refers to the intestine “intestine”. Therefore, an enteroscopy can be understood as small bowel endoscopy or small intestine endoscopy.
Types of Deep Enteroscopy
Double Balloon Enteroscopy (DBE)
Also known as a push-and-pull enteroscopy, this procedure involves the insertion of an endoscope (flexible tube with a miniature camera attached) with an overtube through the small intestine. Balloons are attached at the end of each tube which alternately inflate and deflate in order to move the endoscope through the small intestine.
Single Balloon Enteroscopy (SBE)
A simplified alternative to a double balloon enteroscopy; this procedure involves the use of just one balloon instead of two.
Spiral Enteroscopy
As its name suggests, a spiral enteroscopy involves the use of a rotating spiral positioned over the endoscope, allowing it to move back and forth the small intestine. The main advantage of a spiral enteroscopy is that it allows the endoscope to travel across a larger distance in a shorter period of time.
Who is Deep Enteroscopy for?
Deep enteroscopy is a viable treatment option for patients with bleeding, growths, or strictures in the small intestine. Using this procedure, a doctor will be able to effectively treat any lesions in the gastrointestinal tract, dilate any strictures found there, and remove any polyps or foreign objects.
Generally, your gastroenterologist will recommend a deep enteroscopy if you have the following problems:
- Nausea and vomiting
- Unexplained bleeding in the digestive tract
- Bowel obstruction
- Malnutrition
- Severe diarrhoea
- Crohn’s disease
- Tumours in the small intestines
- Abnormal scan results
Deep Enteroscopy: Diagnostic vs Therapeutic
Deep enteroscopies can be either diagnostic or therapeutic. A doctor may perform a diagnostic deep enteroscopy in order to merely examine the gastrointestinal tract, or retrieve a tissue sample for a biopsy. On the other hand, deep enteroscopies may also be performed to treat polyps, gastrointestinal bleeding, or any obstructions in the gastrointestinal tract.
Diagnostic
Deep enteroscopy could be used as a diagnostic tool to:
- Find the cause of bleeding in the small intestine
- Detect and biopsy strictures (abnormal narrowings, inflammation or scar tissue)
- Detect and biopsy abnormal tissue
- Detect and biopsy polyps or tumours
Therapeutic
Deep enteroscopy serves a therapeutic purpose, and various miniature tools can be attached to the end of the endoscope to:
- Remove polyps within the small intestine
- Widen a stricture
- Remove a foreign body stuck in the small intestine
- Remove a stone
- Implant a stent to prevent the re-narrowing of a section in the small intestine
The small bowel used to be a "no man's land" for Gastroenterologists as they are deep within the abdomen and were difficult to reach with the instruments of the past. Nowadays, however, modern endoscopes with various capabilities allow the Gastroenterologist to access these difficult to reach areas — sometimes saving the patient from having to undergo surgery.
Preparation for Deep Enteroscopy
Deep enteroscopies are typically performed under general anaesthesia or sedation. As such, you may be asked to prepare for the procedure by;
- Abstaining from food and drink 6 hours before the procedure
- Using a laxative or enema prior to the procedure to clear the bowels (for retrograde procedures)
- Avoiding certain medications
Please inform your doctor if you have any allergies and provide him or her with a list of any medications that you have been prescribed on a regular basis.
What can I expect for the Deep Enteroscopy procedure?
During a deep enteroscopy, general anaesthesia or intravenous sedatives will be administered, and a local anaesthetic will be sprayed into the mouth to prevent coughing or gagging during the insertion of the endoscope.
A mouth guard will also be inserted to protect both your teeth and the endoscope. In some instances, this procedure may be accompanied by an X-ray or a fluoroscopy for better localisation.
Depending on the reason for performing a deep enteroscopy, this procedure may be performed on an inpatient or outpatient basis and can take several hours to complete.
After the procedure, your doctor will monitor your condition and inform you of the results of the procedure once the anaesthesia or sedative has worn off. You may be asked to stay at the hospital overnight for further observation. Please note that you should arrange for transport home as you will not be able to drive after the procedure.
Side effects of Deep Enteroscopy
Common side effects of a deep enteroscopy include:
- Sore throat
- Nausea
- Excessive gas or bloating
- Abdominal pain
- Pancreatitis (anterograde procedures)
- Bleeding (relatively uncommon)
These side effects are only temporary and should only last for a short period of time.
Summary
Deep enteroscopies are a safe and effective option when hard-to-reach areas of the gastrointestinal tract are involved. Using balloons attached to endoscopes, a doctor will be able to diagnose and treat any lesions, blockages, or growths located in the gastrointestinal tract. Should you require and be eligible for this procedure, your doctor will inform you of this and be available to answer any questions you may have prior to arranging the procedure.
References
- “Differences in Small & Large Intestines | Children's Pittsburgh.” UPMC Children's Hospital of Pittsburgh, https://www.chp.edu/our-services/transplant/intestine/education/about-small-large-intestines. Accessed 26 May 2022.
- “Enteroscopy Test: Types, Prep, Cost, and More.” Verywell Health, 15 April 2022, https://www.verywellhealth.com/enteroscopy-procedure-4588157#toc-purpose-of-test. Accessed 26 May 2022.
- Moeschler, Oliver, and Karl Mueller. “Deep enteroscopy - indications, diagnostic yield and complications.” NCBI, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4316081/. Accessed 26 May 2022.
- “Enteroscopy.” Johns Hopkins Medicine, https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/enteroscopy. Accessed 26 May 2022.
- “Small Bowel Endoscopy.” Penn State Health, http://pennstatehealth.org/services-treatments/ibd-center/patient-care-treatment/ibd-diagnosis/small-bowel-endoscopy. Accessed 26 May 2022.
