Name of the Procedure:

Small Intestinal Endoscopy (Enteroscopy) Beyond the Second Portion of the Duodenum with Control of Bleeding
Common Name(s): Enteroscopy, Small Bowel Endoscopy
Technical Term: Enteroscopy

Summary

An enteroscopy is a procedure that allows doctors to examine and treat issues in the small intestine beyond the second portion of the duodenum but not including the ileum. It is particularly used to control bleeding using various methods such as injections, cautery, or other devices.

Purpose

Medical Condition or Problem: This procedure addresses gastrointestinal bleeding within the specified portion of the small intestine.
Goals or Expected Outcomes: The primary goal is to locate the source of bleeding and stop it using methods like injection, cautery (bipolar or unipolar), laser, heater probe, stapler, or plasma coagulator.

Indications

Specific Symptoms or Conditions: Unexplained gastrointestinal bleeding, anemia due to bleeding, and other related symptoms.
Patient Criteria: Patients with persistent or recurrent bleeding in the small intestine that cannot be managed through less invasive methods.

Preparation

Pre-procedure Instructions:

• Fasting for at least 8-12 hours before the procedure.
• Instructions to adjust or stop certain medications, such as blood thinners, under medical supervision.
• Possible use of a laxative or enema to clear the intestines. Diagnostic Tests:
• Blood tests
• Imaging studies to locate the bleeding source (e.g., CT scan, MRI)

Procedure Description

Step-by-Step Explanation:

1. The patient is given sedation or anesthesia for comfort.
2. An enteroscope (a long, flexible tube with a camera and instruments) is inserted through the mouth and passed into the small intestine.
3. The doctor examines the intestinal lining to locate the source of bleeding.
4. Once located, the bleeding is controlled using methods like injection, cautery, laser, etc. Tools & Equipment: Enteroscope, injection needles, bipolar/unipolar cautery devices, laser, heater probe, stapler, plasma coagulator.
   Anesthesia or Sedation: Moderate sedation or general anesthesia is typically used.

Duration

The procedure usually takes between 1 to 3 hours, depending on the complexity.

Setting

The procedure is typically performed in a hospital or outpatient surgical center.

Personnel

Healthcare Professionals Involved:

• Gastroenterologist or specialized endoscopist
• Nurses
• Anesthesiologist or nurse anesthetist

Risks and Complications

Common Risks:

• Mild discomfort or pain
• Nausea or bloating Rare Risks:
• Perforation of the intestine
• Infection
• Adverse reaction to sedation or anesthesia Complications Management: Most complications are manageable with prompt medical attention and follow-up care.

Benefits

Expected Benefits: Effective control and management of bleeding in the small intestine, which can improve symptoms and reduce the risk of severe anemia.
Timeframe for Benefits: Benefits often realized shortly after the procedure, with improved symptoms noticed within a few days.

Recovery

Post-Procedure Care:

• Observation until sedation wears off
• Instructions on diet and activity restrictions
• Monitoring for signs of complications Expected Recovery Time: Usually within a few days to a week.
  Follow-Up: Follow-up appointments with the doctor to assess recovery and effectiveness.

Alternatives

Other Treatment Options:

• Capsule endoscopy (for diagnosis)
• Angiography with embolization
• Medication management Pros and Cons:
• Capsule endoscopy is less invasive but not therapeutic.
• Angiography can be effective but is more invasive.
• Medications may manage some symptoms but not resolve the underlying issue.

Patient Experience

During Procedure: Patients are typically sedated and should feel minimal discomfort.
After Procedure: Some bloating, gas, or mild discomfort is common.
Pain Management and Comfort: Pain can usually be managed with over-the-counter pain relievers. Comfort measures include rest and a gradual return to normal diet and activities.