Clin Endosc.  2017 Jul;50(4):328-333. 10.5946/ce.2017.089.

Training in Endoscopy: Enteroscopy

• Kim J

• KMID: 2389237
• DOI: http://doi.org/10.5946/ce.2017.089

Abstract

The balloon-assisted enteroscope has been regarded as the standard device for direct visualization of deep small bowels and allows for the diagnosis and treatment of small bowel disease. At the beginning, its application was focused on the diagnosis of obscure gastrointestinal bleeding, inflammatory bowel disease, and small bowel tumor. However, the indications are being expanded to various therapeutic procedures, not only confined to bleeding control. With the expansion of the indications, the need to perform enteroscopy effectively and safely is increasing. Recent studies have been focused on the diagnostic yield, therapeutic yield, and long-term outcomes of the device. However, with the increasing number of procedures, procedural guidelines and quality indicators are also needed.

Keyword

Enteroscope; Insertion technique; Single-balloon enteroscopy; Double-balloon enteroscopy

MeSH Terms

Diagnosis
Double-Balloon Enteroscopy
Endoscopy*
Hemorrhage
Inflammatory Bowel Diseases

Figure

• 

  Fig. 1. Clockwise or counterclockwise rotation. (A) In clockwise rotation, a large intragastric loop recurred when the scope was pushed to advance it (arrow: pyloric ring, arrowhead: esophagogastric junction). (B) In the counterclockwise rotation, the intragastric loop was effectively controlled without recurrence during insertion.

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  Fig. 2. Grip and pinch technique: The operator grips the enteroscope behind the overtube, between the third and fifth fingers, and the palm and pinches the overtube by using the first and second fingers.

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  Fig. 3. Decision on the optimal insertion direction. (A) Angulation of the small bowel loop in a U-shape around the enteroscope tip visualized with infusion of contrast dye. (B) Without straightening of the U-shape-angulated loop, the stretching of the small bowel is insignificant without advancement after pushing the scope. (C) Withdrawal of the enteroscope backward with an overtube makes the small bowel loop straighter. (D) After release of the angulated enteroscopic tip, the enteroscope and proximal side of the small bowel can be placed in a straight line, which is identical to transferring the pushing force.

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  Fig. 4. Exposure of the muscle layer due to mucosal injury by the overtube.

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