Enteroscopy: Procedure, Purpose, Results, Cost, Price, Online booking

What is Enteroscopy?

Enteroscopy is a procedure that helps your healthcare provider to examine your small intestine. It is used to:

Identify or treat the source of bleeding in your gut
Take a tissue sample (biopsy) from the digestive system for laboratory examination
Remove foreign objects or small bowel polyps (abnormal growths of tissue)
Widen a narrowed part (stricture) of the digestive tract

This procedure is performed either by using capsule endoscopy or flexible enteroscopy. For capsule endoscopy, you would have to swallow a tiny capsule containing a camera. Although capsule endoscopy is a safe method to examine the small intestine, it does not allow to obtain tissue samples or carry out treatments. Flexible enteroscopy involves two methods:

Push enteroscopy: In this method, an endoscope (a long, thin, flexible tube fitted with a camera and light source) is introduced into the gut through the mouth. It goes down into the small intestine till the point where it cannot go further due to sharp bending of the intestine.
Device-assisted enteroscopy: This procedure also involves the insertion of an endoscope into your digestive tract. The only difference is that the endoscope has a tube over it that uses a corkscrew (spiral) or balloons (single balloon, double-balloon) to assist in insertion. However, the use of overtubes is limited due to discomfort and side effects. Device-assisted enteroscopy can be performed via the anus or the mouth.

Why is Enteroscopy performed?
How do you prepare for Enteroscopy?
How is Enteroscopy performed?
What do Enteroscopy results mean?

Why is Enteroscopy performed?

Your healthcare physician may order this test to diagnose diseases of the small intestine. They may ask you to undergo this test in any of the following situations:

Unexplained bleeding in the stomach or intestines
Initial diagnosis of Crohn’s disease (long-term inflammation of the digestive tract)
Tumours in the small intestine
Unexplained diarrhoea
Abnormal X-ray results
To treat people whose small intestine has been identified as the source of bleeding

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How do you prepare for Enteroscopy?

You need to be on an empty stomach for this procedure. Hence, your doctor may ask you to avoid eating or drinking (including water) for approximately 12 hours before the procedure. Talk to your doctor to know when to start fasting.

Tell your healthcare provider about any supplements and medications (including over-the-counter drugs) that you take, especially the ones containing aspirin, iron or bismuth subsalicylate products. He/she may adjust the dose of certain medications that you are already on.

How is Enteroscopy performed?

A nurse will take you to the procedure room where your pulse, blood pressure and oxygen levels will be monitored. The nurse will administer a sedative that may make you drowsy or they will give you anaesthesia that will put you to sleep. Your doctor will then insert the endoscope via your mouth or anus and advance it to your small intestine using X-ray guidance. He/she may use tools such as forceps, heat probes or other devices to treat the part of the bowel that is accessible. The test usually takes up to two hours.

The side effects commonly associated with the procedure include:

Nausea or vomiting
Sore throat
Bloating or cramping

Complications associated with the procedure are:

Tear through the bowel wall
Bleeding at the site of biopsy
Swelling of the pancreas
Reaction to a sedative

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What do Enteroscopy results mean?

Normal results:

Normally, your doctor will not find any source of bleeding, tumours or other abnormalities in your small intestine.

Abnormal results:

Abnormal results may show up as:

Abnormalities in the tissue lining the wall of the small intestine
Abnormal length of blood vessels in the small intestine
Polyps or cancer
Swollen lymph nodes (structures containing cells that fight infection)
Presence of a particular immune cell called PAS-positive macrophages
Radiation enteritis (damage to small intestine due to radiation)
Ulcers

An abnormal result may indicate any of the following conditions or diseases:

Coeliac sprue (a disease where your immune cells damage the small intestine)
Vitamin B12 deficiency
Infectious gastroenteritis (infection in the digestive system)
Lymphoma
Small intestinal cancer
Whipple disease (an infectious intestinal condition that prevents absorption of certain nutrients from food)
Amyloidosis (a condition where an excess of a certain protein called amyloid collects in body organs, affecting their normal functioning)
Crohn’s disease
Giardiasis (diarrhoea caused by the parasite Giardia)
Small intestinal angioectasia (abnormal blood vessels in the small intestine)
Tropical sprue (a rare digestive disease affecting the absorption of nutrients from food)

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

Kovacs TO, Jensen DM. Gastrointestinal hemorrhage. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 135.
Vargo JJ. Preparation for and complications of GI endoscopy. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 41.
Barth B, Troendle D. Capsule endoscopy and small bowel enteroscopy. In: Wyllie R, Hyams JS, Kay M, eds. Pediatric Gastrointestinal and Liver Disease. 5th ed. Philadelphia, PA: Elsevier; 2016:chap 63.
Johns Hopkins Medicine [Internet]. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System; Balloon-Assisted Enteroscopy
The Leeds Teaching Hospitals [internet]: NHS Foundation Trust. National Health Service. U.K.; Endoscopy
National Health Service [internet]. UK; Endoscopy
ASGE Technology Committee, Chauhan SS, Manfredi MA, Abu Dayyeh BK, Enestvedt BK, Fujii-Lau LL, et al. Enteroscopy. Gastrointest Endosc. 2015 Dec;82(6):975-90. PMID: 29061266.
Science Direct (Elsevier) [Internet]; Push Enteroscopy
Brigham Health: Brigham and Women's Hospital [Internet]. Harvard Medical School Teaching Hospital. Boston. MA. US; Small Bowel Enteroscopy
Genetic and Rare Diseases Information Center. National Center for Advancing Translational Sciences. National Institute of Health. U.S. Department of Health and Human Services; Crohn's disease
Nemours Children’s Health System [Internet]. Jacksonville (FL): The Nemours Foundation; c2017; Word! Lymph Node
Waheed A, Fatima R, Aziz M. Radiation Enteritis. [Updated 2019 Jun 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan
Better health channel. Department of Health and Human Services [internet]. State government of Victoria; Gastroenteritis
American Cancer Society [internet]. Atlanta (GA). USA; Lymphoma
Cedars Sinai [Internet]: Cedars Sinai Medical Center. Los Angeles. US; Amyloidosis
Centers for Disease Control and Prevention [internet]. Atlanta (GA): US Department of Health and Human Services; Giardia
American College of Gastroenterology [internet]. Bethesda. Maryland. US; Small Bowel Bleeding