Name of the Procedure:

Small Intestinal Endoscopy (Enteroscopy Beyond Second Portion of Duodenum, Not Including Ileum); with Biopsy, Single or Multiple

Summary

Small intestinal endoscopy, also known as enteroscopy, is a medical procedure used to examine the interior of the small intestine beyond the second portion of the duodenum but not including the ileum. During this procedure, a flexible tube with a camera (endoscope) is inserted through the mouth to view the small intestine and take tissue biopsies if necessary.

Purpose

Enteroscopy is performed to diagnose, monitor, and sometimes treat conditions affecting the small intestine. The goal is to identify abnormalities such as inflammation, ulcers, tumors, or bleeding sources and to obtain tissue samples for further examination when needed.

Indications

• Unexplained abdominal pain
• Long-term diarrhea
• Gastrointestinal bleeding
• Suspected small intestine tumors or polyps
• Celiac disease diagnosis or monitoring
• Unexplained weight loss
• Iron deficiency anemia

Preparation

• Patients may need to fast (no food or drink) for about 8-12 hours before the procedure.
• Medications that can affect bleeding may need to be temporarily adjusted.
• Diagnostic tests like blood tests may be required in advance.

Procedure Description

1. The patient is sedated or given local anesthesia to ensure comfort.
2. A flexible endoscope is inserted through the mouth and guided through the esophagus, stomach, and beyond the second portion of the duodenum.
3. The endoscope transmits video images for the doctor to examine the small intestine lining.
4. Special tools passed through the endoscope are used to collect biopsies if abnormalities are detected.
5. The endoscope is carefully withdrawn.

Equipment used includes a high-definition endoscope with biopsy forceps.

Duration

The procedure typically takes about 60 minutes but can vary.

Setting

Small intestinal endoscopy is usually performed in a hospital, outpatient clinic, or specialized endoscopy center.

Personnel

• Gastroenterologist
• Endoscopy nurse or technician
• Anesthesiologist (if sedation or general anesthesia is used)

Risks and Complications

• Sore throat or minor discomfort
• Bleeding at biopsy sites
• Perforation of the intestinal wall (rare)
• Infection
• Adverse reactions to sedatives

Complications, if they occur, are managed with medical intervention, such as monitoring, medication, or surgery.

Benefits

• Accurate diagnosis of small intestine conditions
• Ability to take direct tissue samples for analysis
• Early detection of cancers or other serious conditions
• Guided treatment decisions based on findings

Benefits are often realized immediately through the identification of conditions or initiation of appropriate treatment plans.

Recovery

• Patients may need to rest for a few hours post-procedure due to sedation.
• Mild throat discomfort or bloating may be experienced.
• Normal activities can usually be resumed within 24 hours.
• Follow-up appointments may be scheduled to discuss biopsy results.

Alternatives

• Capsule endoscopy: Swallowing a small, camera-equipped capsule to visualize the small intestine.

  • Pro: Non-invasive.
  • Con: Cannot take biopsies or perform therapeutic interventions.

• CT or MRI enterography: Imaging studies to visualize the small intestine.

  • Pro: Non-invasive.
  • Con: Less detailed and cannot obtain tissue samples.

Patient Experience

Patients generally feel minimal discomfort due to sedation. A sore throat or mild bloating may occur post-procedure. Pain management measures include over-the-counter pain relief and staying hydrated. The care team strives to ensure patient comfort throughout the entire process.