Enteroscopy

Definition

Enteroscopy is a procedure used to examine the small intestine (small bowel).

Alternative Names

Push enteroscopy; Double-balloon enteroscopy; Capsule enteroscopy

How the Test is Performed

A thin, flexible tube (endoscope) is inserted through the mouth and into the upper gastrointestinal tract. During a double-balloon enteroscopy, balloons attached to the endoscope can be inflated to allow the doctor to view a section of the small intestine.

In a colonoscopy, a flexible tube is inserted through your rectum and colon. The tube can most often reach into the end part of the small intestine (ileum). Capsule endoscopy is done with a disposable capsule that you swallow.

Tissue samples removed during enteroscopy are sent to the lab for examination. (Biopsies cannot be taken with a capsule endoscopy.)

How to Prepare for the Test

Do not take products containing aspirin for 1 week before the procedure. Tell your health care provider if you take blood thinners such as warfarin (Coumadin), clopidogrel (Plavix), or apixaban (Eliquis) because these may interfere with the test. Do not stop taking any medicine unless told to do so by your provider.

Do not eat any solid foods or milk products after midnight the day of your procedure. You may have clear liquids until 4 hours before your exam.

You must sign a consent form.

How the Test will Feel

You will be given calming and sedating medicine for the procedure and will not feel any discomfort. You may have some bloating or cramping when you wake up. This is from air that is pumped into the abdomen to expand the area during the procedure.

A capsule endoscopy causes no discomfort.

Why the Test is Performed

This test is most often performed to help diagnose diseases of the small intestines. It may be done if you have:

• Abnormal x-ray results
• Tumors in the small intestines
• Unexplained diarrhea
• Unexplained gastrointestinal bleeding

Normal Results

In a normal test result, the provider will not find sources of bleeding in the small bowel, and will not find any tumors or other abnormal tissue.

What Abnormal Results Mean

Signs may include:

• Abnormalities of the tissue lining the small intestine (mucosa) or the tiny, finger-like projections on the surface of the small intestine (villi)
• Abnormal lengthening of blood vessels (angioectasis) in the intestinal lining
• Immune cells called PAS-positive macrophages
• Polyps or cancer
• Radiation enteritis
• Swollen or enlarged lymph nodes or lymphatic vessels
• Ulcers

Changes found on enteroscopy may be signs of disorders and conditions, including:

• Amyloidosis
• Celiac sprue
• Crohn disease
• Folate or vitamin B12 deficiency
• Giardiasis
• Infectious gastroenteritis
• Lymphangiectasia
• Lymphoma
• Small intestinal angiectasia
• Small intestinal cancer
  
• Tropical sprue
• Whipple disease

Risks

Complications are rare but may include:

• Excessive bleeding from the biopsy site
• Hole in the bowel (bowel perforation)
• Infection of the biopsy site leading to bacteremia
• Vomiting, followed by aspiration into the lungs
• The capsule endoscope can cause a blockage in a narrowed intestine with symptoms of abdominal pain and bloating
  
  

Considerations

Factors that prohibit use of this test may include:

• Uncooperative or confused person
• Untreated blood clotting (coagulation) disorders
• Use of aspirin or other medicines that prevent the blood from clotting normally (anticoagulants)

The greatest risk is bleeding. Signs include:

• Abdominal pain
• Blood in the stools
• Vomiting blood

References

Marcinkowski P, Fichera A. Management of lower gastrointestinal bleeding. In: Cameron AM, Cameron JL, eds. Current Surgical Therapy. 13th ed. Philadelphia, PA: Elsevier; 2020:341-347.

Rojas I, Barth B. Capsule endoscopy and small bowel enteroscopy. In: Wyllie R, Hyams JS, Kay M, eds. Pediatric Gastrointestinal and Liver Disease. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 63.

Sugumar A, Vargo JJ. Preparation for and complications of gastrointestinal endoscopy. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier ; 2021:chap 42.

Waterman M, Zurad EG, Gralnek IM. Video capsule endoscopy. In: Fowler GC, ed. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 93.