What is Deep Enteroscopy?
Deep enteroscopy is an advanced endoscopic procedure used to visualize and manage disorders of the small intestine, an area traditionally difficult to access through standard endoscopy. It plays a pivotal role in diagnosing and treating obscure gastrointestinal bleeding, small bowel tumors, Crohn’s disease, and other small intestinal pathologies.
Types of Deep Enteroscopy
There are several techniques used to perform deep enteroscopy, each based on the mechanism of scope advancement including:
- Double-Balloon Enteroscopy (DBE): This method employs two balloons – one on the tip of the enteroscope and another on an overtube. Alternating inflation and deflation of these balloons allow the scope to pleat the intestine and advance deep into the small bowel.
- Single-Balloon Enteroscopy (SBE): This is similar to DBE but utilizes only one balloon on the overtube, simplifying the technique and reducing procedural time in some cases.
- Spiral Enteroscopy: A spiral-shaped overtube is rotated to pleat the intestine and help the enteroscope move forward. This method can be either manual or motorized.
Indications for Deep Enteroscopy
Deep enteroscopy is indicated in the following conditions:
- Obscure gastrointestinal bleeding (particularly when upper and lower endoscopies are inconclusive)
- Small bowel tumors or polyps
- Suspected Crohn’s disease with small bowel involvement
- Unexplained chronic abdominal pain
- Evaluation of abnormal imaging findings (e.g., capsule endoscopy, CT enterography)
Procedure of Deep Enteroscopy
Deep enteroscopy involves the following steps:
- Preparation: Before the procedure, patients are instructed to fast for at least 8–12 hours. If the enteroscopy is done via the rectum, bowel preparation (similar to colonoscopy) is required. Sedation or general anesthesia is administered for comfort, and informed consent is obtained after explaining the procedure and potential risks.
- Scope Insertion: The endoscope is inserted either through the mouth (anterograde) or the rectum (retrograde), depending on the area of the small intestine being examined. Specialized devices—such as a double-balloon, single-balloon, or spiral overtube—are used to advance the scope deep into the small bowel.
- Examination and Treatment: As the endoscope progresses, the physician inspects the small intestine lining and can perform treatments as needed. These may include taking biopsies, removing polyps, controlling bleeding, or dilating narrowed areas.
- Completion and Recovery: After the examination, the scope is slowly withdrawn. Patients are monitored in the recovery area as the sedation wears off. Most individuals can return home the same day, although some may experience mild bloating or discomfort.
Diagnostic and Therapeutic applications of Deep Enteroscopy
Deep enteroscopy has the following diagnostic and therapeutic applications including:
- Biopsy collection from suspicious lesions
- Polypectomy for small bowel polyps
- Dilation of strictures
- Hemostasis in cases of active bleeding
- Foreign body retrieval
Advantages of Deep Enteroscopy
Some of the benefits of deep enteroscopy are:
- It allows direct visualization and intervention in areas unreachable by traditional scopes.
- It facilitates histopathological diagnosis through tissue sampling.
- It reduces the need for more invasive procedures like intraoperative enteroscopy.
Limitations and Risks of Deep Enteroscopy
Deep enteroscopy limitations include:
- It is technically demanding and time-consuming
- It requires specialized equipment and training
- Possible complications such as pancreatitis, perforation, bleeding, aspiration, or cardiorespiratory events related to sedation
Post-Procedural Care of Deep Enteroscopy
Individuals are observed for signs of complications like abdominal pain, fever, or rectal bleeding. Most individuals can resume normal activities the following day unless therapeutic interventions were performed.
Conclusion
Deep enteroscopy has significantly improved the diagnostic and therapeutic approach to small bowel diseases. It bridges the gap between non-invasive imaging and surgical intervention, providing a minimally invasive yet effective tool for small bowel evaluation and management.
