Enteroscopy

Definition

Enteroscopy is a procedure used to examine the small intestine (small bowel).

Alternative Names

Small bowel biopsy; Push enteroscopy; Double-balloon enteroscopy; Capsule enteroscopy; Sonde enteroscopy

How the test is performed

A thin, flexible tube (endoscope) is usually inserted through the mouth and into the upper gastrointestinal tract. During a double-balloon enteroscopy, balloons attached to the endoscope can be inflated to allow the doctor to view a large part of the small intestine.

In a colonoscopy, a flexible tube is inserted through your rectum and colon. The tube usually can reach into the end part of the small intestine (ileum). See also: Colonoscopy

Tissue samples removed during enteroscopy are sent to the laboratory for examination.

How to prepare for the test

Do not take products containing aspirin for 1 week before the procedure. Tell your doctor if you take blood thinners such as warfarin (Coumadin) or clopidogrel (Plavix), because these may interfere with the test. Do NOT stop taking any medication unless told to do so by your health care provider.

Do not eat any solid foods or milk products after midnight the day of your procedure. You may have clear liquids until 4 hours before your exam.

You must sign a consent form.

How the test will feel

When the tube is put into your mouth and down your esophagus (food pipe), you may feel like gagging. You will get a numbing medicine to reduce this feeling.

You may get a mild sedative, but only in small doses because you must stay alert enough to help with the procedure (by doing such things as swallowing and turning). The biopsy sampling causes little or no pain, although you may have some mild cramping.

Why the test is performed

This test is most often performed to help diagnose diseases of the small intestines. It may be done if you have:

• Abnormal x-ray results
• Tumors in the small intestines
• Unexplained diarrhea
• Unexplained gastrointestinal bleeding

Normal Values

In a normal test result, the health care provider will not find sources of bleeding in the small bowel, and will not find any tumors or other abnormal tissue.

What abnormal results mean

Signs may include:

• Abnormalities of the tissue lining the small intestine (mucosa) or the tiny, finger-like projections on the surface of the small intestine (villi)
• Abnormal lengthening of blood vessels (angiectasis) in the intestinal lining
• Immune cells called PAS-positive macrophages
• Polyps or cancer
• Radiation enteritis
• Swollen or enlarged lymph nodes or lymphatic vessels
• Ulcers

Changes found on enteroscopy may be signs of disorders and conditions, including:

• Amyloidosis
• Celiac sprue
• Crohn's disease
• Folate or vitamin B12 deficiency
• Giardiasis
• Infectious gastroenteritis
• Lymphangiectasia
• Lymphoma
• Small intestinal angiectasia
• Tropical sprue
• Whipple's disease

What the risks are

Complications are rare but may include:

• Excessive bleeding from the biopsy site
• Hole in the bowel (bowel perforation)
• Infection of the biopsy site leading to bacteremia
• Vomiting, followed by aspiration into the lungs

Special considerations

Factors that prohibit use of this test may include:

• Uncooperative or confused patients
• Untreated blood clotting (coagulation) disorders
• Use of aspirin or other medicines that prevent the blood from clotting normally (anticoagulants)

The greatest risk is bleeding. Signs include:

• Abdominal pain
• Blood in the stools
• Vomiting blood

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References

Jensen DM. Gastrointestinal hemorrhage and occult gastrointestinal bleeding. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 137.

Sidhu R, Sanders DS, Morris AJ, McAlindon ME. Guidelines on small bowel enteroscopy and capsule endoscopy in adults. Gut. 2008;57:125-136.