Table of Contents
Introduction
The small intestine comprises the duodenum, jejunum, and ileum. It is a very long section of the small bowel between the stomach and colon (or the large intestine). A procedure used to examine this part of the body is called enteroscopy.
What Is Push Enteroscopy?
Push enteroscopy is also called push endoscopy. It enables diagnosing and treating diseases in the upper part of the small intestine. The duodenum and the initial parts of the jejunum can be viewed using an endoscope in this procedure. The device is inserted through the mouth. It is gradually moved by gentle pushing action through the duodenum, stomach, and jejunum. A biopsy (tissue sample) may be obtained if necessary. The process can also be used to treat certain concerns. A newer kind of enteroscopy is now available to view the lower portion of the small intestine. It can enter the lower small bowel by passing through the rectum. To help guide the endoscope as far as necessary, balloons are occasionally used with these instruments.
What Are the Indications of a Push Enteroscopy?
If there is a potential abnormality in the upper part of the small bowel that could be causing recurring or persistent symptoms, a gastroenterologist may recommend push enteroscopy. This advanced process is often used as a recheck after other diagnostic procedures, such as radiological imaging tests or upper endoscopy, colonoscopy, or capsule endoscopy. The common symptoms may include:
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Persistent abdominal pain.
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Bleeding.
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Diarrhea.
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Anemia.
What Are the Advantages of Push Enteroscopy?
Push endoscopy is an effective method for diagnosing and treating conditions in the small intestine. For example, push endoscopy can be useful in both analyzing and stopping bleeding in patients with intermittently bleeding angiodysplasias (clusters of weakened blood vessels) located in the small intestine beyond the reach of a standard upper endoscope. The primary benefits of push enteroscopy are the availability and the ability to perform therapy and biopsy with the device.
What Are the Disadvantages of Push Enteroscopy?
There are some limitations with push enteroscopy. Since its reach is still restricted, it cannot diagnose lesions in the small intestine that are distal to the colon. As with other endoscopic procedures, the main risks of push endoscopy are bleeding and intestinal perforation from either endoscopic passage or the therapeutic procedures that go along with it. The risk of perforation is most likely higher with push enteroscopy due to using an overtube (of a larger diameter) than with an endoscope alone. In addition, it is technically challenging, time-consuming, and has a moderate risk of complications. The procedure may take about half an hour to be completed. However, unintentional displacement of location or position inaccuracies can happen often. As a result, the procedure may be more time-consuming in such situations.
How Is Push Enteroscopy Done?
Push enteroscopy can be carried out using colonoscopes or specialized enteroscopes. A colonoscopy is an instrument that is similar to an endoscope, but it can be used to view the entire colon and the terminal ileum. It is a longer version of standard endoscopes, measuring 78.7 to 98.4 inches inches in working length, 10.5 to 11.7 mm in external diameter, and 2.8 to 3.8 mm in channel diameter. However, deeper insertion or greater diagnostic yield may not always correlate with the length of the instrument. It is unclear whether using over tubes during push enteroscopy allows for a deeper insertion depth and, consequently, an improved diagnostic yield. The use of over tubes may not always be feasible. This is mainly due to the increased patient discomfort it causes and the numerous side effects recorded in the literature.
The endoscope is inserted through the mouth and moved as far as it can into the small bowel before the instrument forms loops, preventing further advancement. Torque and withdrawal are used to minimize loops. The endoscope is then advanced again, and the procedure is repeated. If these techniques are insufficient to advance the endoscope, the patient can be positioned slightly differently, and abdominal pressure can be applied. Stiffening the instrument might enable further advancement if a variable stiffness colonoscope is used.
When an overture is used in a procedure, it is transferred up to the endoscope's hub before insertion. After that, the endoscope is moved to the second or third segment of the duodenum, where loop reduction is carried out.
How Efficient Is Push Enteroscopy?
The procedure does not require any specific training. Hence, anyone with basic medical knowledge can perform it with proper guidance. Currently, it is usually carried out for studying lesions in the upper part of the small intestine that are either not accessible by routine EGD (esophagogastroduodenoscopy) or identified by prior imaging up to the proximal jejunum. The depth of insertion can be determined before the procedure. Push enteroscopy has a twenty to eighty percent diagnostic yield for uncertain gastrointestinal bleeding. However, many of the lesions discovered during a push enteroscopy can be reached with a regular gastroscope. Overt bleeding is associated with a higher likelihood of positive results with push enteroscopy, which can alter the course of treatment for 40 percent to 75 percent of patients.
Because push enteroscopy with a colonoscope does not require specialized training, it is easily accessible and user-friendly. In addition, general anesthesia is not usually needed, and it is well tolerated with moderate levels of conscious sedation if required. The process is more laborious when a specialized push enteroscope and overtube are used. There can be fluid spilling from the proximal overtube hub around the enteroscopy, air inflation may be restricted by air escaping through the overtube, and fine movement of the endoscope tip becomes more challenging.
Conclusion:
A push enteroscopy might require about thirty minutes to an hour. There can be a sore throat after the procedure. Some patients might experience bloating and gassiness. Vomiting or an upset stomach might be present in some others. The patient will be advised to rest for a while for recovery. Depending on their condition, some patients might be advised restrictions in diet and medication. However, being user-friendly, push endoscopy is useful for identifying and treating small intestinal disorders.
