Name of the Procedure:

Small Intestinal Endoscopy, Enteroscopy Beyond Second Portion of Duodenum, Not Including Ileum with Removal of Foreign Body(s)

Summary

Small intestinal endoscopy, also known as enteroscopy, is a medical procedure used to examine and treat the small intestine. This specific procedure involves inserting an endoscope beyond the second portion of the duodenum to remove foreign bodies from the small intestine, excluding the ileum.

Purpose

The main purpose of the small intestinal endoscopy with foreign body removal is to identify and retrieve foreign objects lodged in the small intestine to prevent or address complications like obstruction, perforation, infection, or hemorrhage. The goal is to ensure the safe removal of the foreign body and restore normal digestive function.

Indications

• Symptoms such as abdominal pain, vomiting, or gastrointestinal bleeding.
• Imaging studies (e.g., X-rays, CT scans) indicating the presence of a foreign body in the small intestine.
• Patients who have ingested non-digestible items that could cause complications.
• Unresolved gastrointestinal symptoms despite initial treatments.

Preparation

• Fasting for at least 8 hours before the procedure.
• Adjustments to certain medications as directed by the healthcare provider (e.g., blood thinners, diabetes medication).
• Pre-procedure diagnostic tests such as imaging studies to locate the foreign body.
• Informing the healthcare team about any allergies or existing medical conditions.

Procedure Description

1. The patient is sedated or placed under general anesthesia to ensure comfort.
2. An endoscope, a flexible tube with a camera and light, is inserted through the mouth and guided beyond the second portion of the duodenum.
3. The endoscope transmits images to a monitor, allowing the physician to locate and assess the foreign body.
4. Special instruments passed through the endoscope are used to grasp and remove the foreign body.
5. Once the foreign body is removed, the endoscope is carefully withdrawn.

Duration

The procedure typically takes between 30 minutes to 2 hours, depending on the complexity and location of the foreign body.

Setting

The procedure is performed in a hospital, outpatient clinic, or surgical center equipped with endoscopy facilities.

Personnel

• Gastroenterologist or a specialized endoscopist
• Nurses or endoscopy technicians
• Anesthesiologist or a nurse anesthetist

Risks and Complications

• Common risks: Sore throat, mild bleeding, abdominal discomfort.
• Rare risks: Perforation of the intestinal wall, infection, severe bleeding, adverse reactions to anesthesia.
• Management includes monitoring, medications, or surgical intervention if necessary.

Benefits

• Safe and effective removal of foreign bodies.
• Relief of symptoms and prevention of potential complications.
• The patient typically begins to feel the benefits immediately or within a few days.

Recovery

• Post-procedure observation for a few hours to monitor for immediate complications.
• Instructions for a gradual return to normal diet and activities.
• Possible short-term dietary restrictions.
• Follow-up appointments to ensure the recovery and address any remaining symptoms.

Alternatives

• Watchful waiting in cases where the foreign body might pass naturally.
• Endoscopic procedures such as capsule endoscopy which are diagnostic but not therapeutic.
• Surgical removal in cases where endoscopy is not feasible or unsuccessful.
• Each alternative has its own set of risks, benefits, and considerations.

Patient Experience

During the procedure, patients are usually under sedation or anesthesia and will not feel pain. After the procedure, there might be mild discomfort such as a sore throat or abdominal bloating. Pain management and comfort measures are provided to ensure a smooth recovery. Most patients can resume normal activities within a few days, following specific post-procedure guidelines.