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Enteroscopy includes several types of procedures that allow a physician to look further into the small bowel (which is up to 20 feet long) than is possible with other methods mentioned here. A physician may use a longer conventional endoscope, a double-balloon endoscope or a capsule endoscope. Enteroscopy is primarily used to find the source of intestinal bleeding, but can also be used to find lesions and determine causes for nutritional malabsorption.
An extended version of the conventional endoscope, called a "push endoscope,"may be employed to study the upper part of the small intestine down to about 40 inches beyond the stomach. While more of the small bowel is accessible with this type of endoscopy than with EGD, it is able to visualize only a limited portion of the small bowel. The same techniques for therapy used during EGDs are possible during push enteroscopy.
Capsule endoscopy uses a swallowable capsule containing tiny video cameras. The capsule, about the size of a large vitamin pill, contains a light source, batteries, a radio transmitter and an antenna. The capsule transmits the images to a recording device worn around the patient's waist. When complete, the recording is downloaded to a computer which displays it on a screen. The capsule is disposable and usually takes eight hours to move through the digestive system, after which it is passed harmlessly in a bowel movement. Capsule endoscopy does not require sedation and is painless. Capsule endoscopy can be used to diagnose hidden GI bleeding, Crohn's disease, celiac disease, and other malabsorption problems, tumors (benign and malignant), vascular malformations, medication injury, and to a lesser extent, esophageal disease. Currently, capsule endoscopy cannot be used to biopsy or treat any conditions. See also the media backgrounder on capsule endoscopy.
Double-balloon enteroscopy uses a basic endoscope for viewing the inside of the entire small bowel, but that endoscope travels inside another tube which is pulled along the inside of the small bowel or colon by alternately inflating and deflating two small balloons against the inside of the intestinal wall. This allows the scope to travel further, give stable images, perform biopsies, remove polyps, and perform other therapies. This procedure is done under sedation to assure patient comfort. A similar method using a single-balloon device has been recently developed. These procedures can be performed with or without the assistance of an X-ray machine (fluoroscopy). See also the media backgrounder on balloon-assisted enteroscopy.
For more information see the ASGE patient education brochure "Understanding Capsule Endoscopy" online at www.asge.org.