Name of the Procedure:

Small intestinal endoscopy, enteroscopy beyond the second portion of the duodenum, including the ileum; with control of bleeding (e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator).

Summary

A small intestinal endoscopy, also known as enteroscopy, is a medical procedure that involves inserting a flexible tube with a camera (endoscope) into the digestive tract to examine and treat areas beyond the second portion of the duodenum, including the ileum. This procedure often includes methods to control bleeding, such as injections or thermal techniques.

Purpose

The procedure addresses conditions causing bleeding in the small intestine. The goal is to identify the bleeding source and stop it, thereby preventing further blood loss and associated complications.

Indications

Symptoms warranting the procedure include unexplained gastrointestinal bleeding, anemia from unknown sources, and visible blood in stool. It is appropriate for patients experiencing these symptoms despite other diagnostic findings being inconclusive.

Preparation

Patients may be required to fast for a specified period before the procedure. Medications that affect blood clotting might need to be adjusted. Pre-procedure diagnostic tests might include blood tests, imaging studies, and other endoscopic examinations.

Procedure Description

The patient is typically sedated or under general anesthesia. The endoscope is carefully inserted through the mouth and navigated into the small intestine. The physician examines the intestinal lining and applies techniques to control any bleeding detected, using tools like bipolar cautery, laser, or injection needles. Specialized equipment on the endoscope aids in these interventions.

Duration

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

Setting

It is performed in a hospital, outpatient clinic, or specialized surgical center.

Personnel

The procedure involves a gastroenterologist, assisted by nurses and potentially an anesthesiologist if sedation or general anesthesia is used.

Risks and Complications

Common risks include mild discomfort, nausea, and bloating. Rare complications might involve perforation of the intestine, infection, and adverse reactions to sedation or anesthesia. Bleeding might also occur but is generally managed during the procedure.

Benefits

The primary benefit is the cessation of intestinal bleeding, leading to stabilization of blood counts and relief from related symptoms. The effects are usually immediate, though monitoring may be necessary.

Recovery

Post-procedure instructions include rest, a gradual return to normal diet, and avoidance of certain medications as advised. Recovery time is typically short, ranging from a few hours to a day. Follow-up appointments ensure that the bleeding has been controlled and assess for any further interventions needed.

Alternatives

Alternative treatments include non-invasive imaging techniques, like capsule endoscopy, or other types of endoscopy that might not reach as far but could be sufficient depending on the case. Each alternative has its own advantages and limitations compared to enteroscopy.

Patient Experience

Patients may feel mild throat discomfort after the procedure due to the insertion of the endoscope. Pain management strategies include lozenges and mild pain relievers. Post-procedure sedation effects may cause drowsiness, so arranging for transportation home is recommended. Comfortable surroundings and informative staff interactions aim to ease patient anxiety and promote a positive experience.