[Endoscopic study of the small intestine with push enteroscopy. A prospective study]

[Endoscopy of the small bowel: light into the dark]

Since the introduction of capsule endoscopy and later balloon enteroscopy in clinical practice, endoscopic examination of the small bowel has dramatically improved. For the first time, it is possible to diagnose the whole small bowel without the necessity of laparotomy and intraoperative enteroscopy. The methods revolutionized the field of small bowel diagnostic and therapy and become part of daily clinical practice. This article provides a review of small bowel enteroscopic methods.

The value of double-balloon enteroscopy in patients with refractory celiac disease

OBJECTIVE

Patients with refractory celiac disease can develop enteropathy-associated T-cell lymphoma (EATL) or ulcerative jejunitis. Double-balloon enteroscopy allows examination of the small bowel. We prospectively assessed the value of this technique in patients with refractory celiac disease in a tertiary referral center.

METHODS

Small bowel enteroscopy was performed in a total of 21 consecutive patients for lesions like ulcerations (high risk). Biopsy specimens were taken from such lesions and from examined small bowel at three different levels of scope insertion depth. Tissue specimens were evaluated for the modified Marsh classification and for the presence of EATL.

RESULTS

Twenty-four procedures were successfully performed without complications. EATL was found in five patients (24%, 95% CI 10-45%) as circumferential, discrete, or confluent ulcerations. In three of them, Marsh III was found while in the other two patients with EATL Marsh I was found. Another two patients (9%, 95% CI 2-28%) had ulcerative jejunitis in the absence of EATL and histology was compatible with Marsh III. In the remaining 14 patients (54%, 95% CI 35-73%), no high-risk lesions were found. Double-balloon enteroscopy could exclude the presence of EATL in four patients that was suggested by abdominal computerized tomography.

CONCLUSIONS

Complications of refractory celiac disease like ulcerative jejunitis or EATL could efficiently be detected or excluded by double-balloon enteroscopy. This technique should be reserved for patients with refractory celiac disease or patients with a past history of EATL.

Push enteroscopy: a single centre experience and review of published series

BACKGROUND

To assess the efficacy of push enteroscopy in a single tertiary hospital and review the available literature to assess the overall diagnostic yield of push enteroscopy.

METHODS

Review of a database on push enteroscopy in a tertiary hospital from 1997 to 1999. This included 100 consecutive patients who underwent push enteroscopy. Review of all large published series on push enteroscopy to date to obtain an overall diagnostic yield.

RESULTS

The diagnostic yield for patients with gastrointestinal (GI) bleeding was 47% and for patients with suspected small bowel disease was 33%. Angiodysplasia was the most common diagnosis in patients with GI blood loss. Patients with active GI bleeding had a higher diagnostic yield. The procedure was tolerated well and no complications occurred. Review of the literature showed an overall diagnostic yield of 44% (498 of 1 136 patients) for patients with GI blood loss and 38% (108 of 286 patients) for suspected small bowel disease.

CONCLUSIONS

Push enteroscopy has a good diagnostic yield and is valuable in patients with GI blood loss and suspected small bowel disease.