Name of the Procedure:

Small Intestinal Endoscopy (Enteroscopy Beyond Second Portion of Duodenum, Excluding Ileum) with Ablation of Tumors, Polyps, or Other Lesions Not Amenable to Removal by Hot Biopsy Forceps, Bipolar Cautery, or Snare Technique

Summary

This procedure involves the use of a specialized endoscope to examine and treat abnormalities such as tumors or polyps in the small intestine beyond the second portion of the duodenum. It specifically targets lesions that cannot be removed by simpler methods like hot biopsy forceps or snare techniques and uses ablation to destroy these growths.

Purpose

The main goal is to identify and ablate abnormal growths in the small intestine, such as tumors or polyps, that pose health risks and cannot be removed by less invasive means. This helps prevent potential complications like bleeding, obstruction, or transformation into cancer.

Indications

• Unexplained gastrointestinal bleeding
• Suspicion of small intestine tumors or polyps based on imaging or prior endoscopies
• Known polyps or tumors that can't be removed by simpler endoscopic methods
• Abdominal pain of unknown origin where lesions are suspected

Patients appropriate for this procedure often have specific symptoms like persistent gastrointestinal bleeding or have undergone diagnostic tests indicating the presence of non-removable lesions.

Preparation

• Patients may be required to fast for a certain period before the procedure.
• Adjustments or temporary discontinuation of certain medications, particularly blood thinners.
• Pre-procedure diagnostic tests like CT scans, MRI, or capsule endoscopy might be necessary.

Procedure Description

1. The patient is typically sedated or given general anesthesia.
2. An endoscope with a camera and ablation equipment is inserted through the mouth, passed through the stomach, and into the small intestine.
3. The endoscopist navigates to the target area beyond the second portion of the duodenum.
4. Ablation techniques (e.g., thermal, laser, or radiofrequency) are used to destroy the targeted tumor(s) or polyp(s).
5. The area is examined for completeness of the ablation and any immediate complications.
6. The endoscope is carefully withdrawn.

Duration

Approximately 1 to 2 hours, depending on the complexity and number of lesions.

Setting

Typically performed in a hospital endoscopy suite or a specialized outpatient surgical center.

Personnel

• Gastroenterologist or surgical endoscopist
• Nurses
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

• Bleeding
• Perforation of the intestine
• Infection
• Adverse reactions to sedation or anesthesia
• Incomplete ablation requiring subsequent procedures

Benefits

• Effective treatment of small intestinal lesions not removable by simpler methods
• Potential reduction or elimination of symptoms like bleeding
• Decreased risk of benign lesions becoming cancerous
• Improvement in overall gastrointestinal function

Recovery

• Monitoring in the recovery area until sedation effects wear off
• Resume normal diet gradually
• Avoid strenuous activities for 24-48 hours
• Possible follow-up endoscopy or imaging to ensure complete ablation and healing

Alternatives

• Medical management for symptom control if endoscopic removal isn't feasible
• Surgical resection of the affected intestinal segment, which is more invasive
• Pros and cons: Medical management might not address the underlying issue; surgical resection involves greater risks and a longer recovery time.

Patient Experience

Patients may feel drowsy or groggy post-procedure due to sedation. There might be mild throat discomfort from the endoscope insertion. Pain is usually minimal but managed with medication if needed. Most patients can return to regular activities within a couple of days, following specific recovery instructions provided by the healthcare team.