CLINICAL ASSOCIATE PROFESSOR, SYDNEY UNIVERSITY
GASTROENTEROLOGIST AND THERAPEUTIC ENDOSCOPIST
CHAIRMAN OF ENDOSCOPY, GASTROENTEROLOGY
SOCIETY OF AUSTRALIA
Small Bowel Endoscopy
What does this involve?
Small bowel disorders are common and include bleeding, tumours and Crohn’s disease. There are several methods used to examine the small bowel but new technologies have changed the way we look at the small bowel. Capsule endoscopy (CE) and device assisted endoscopy (DAE) have replaced more traditional tests like x-rays and CAT (CT) scans.
Why is SBE done?
The most common reason for examination of the small bowel is anaemia and bleeding. The combination of capsule endoscopy and device assisted endoscopy allows for the most accurate diagnosis and therapy. it is now common that abnormalities are found and treated successfully.
What is involved in capsule endoscopy?
This is a very safe and easy test. Minimal preparation is required and no sedation or anaesthetic is required. The capsule is swallowed and a recorder is strapped to the waist to read the video signal sent from the electronic capsule. The capsule has a 10-12 hour battery life and this can be seen as a flashing blue light. When the light stops flashing the battery has ended. The recorder is then downloaded to our computers and a video is created for us to view. You are free to do almost anything you wish when the recorder is attached so shopping, work and taking a stroll are all okay.
Picture of the capsule endoscopy
What is involved in DAE?
This is a series of very similar endoscopes that all do very similar jobs. The first was the double balloon system but recently the single balloon system and spirus systems have been available. They can approach the small bowel from the mouth through the stomach or from the back passage through the colon. For the patient it is very similar to either endoscopy from the mouth or colonoscopy with the procedure taking longer to complete.
Picture of the double balloon endoscope and entry into the small bowel via the stomach.
What about my current medications or allergies?
Tell your doctor in advance of the procedure about all medications that you're taking and about any allergies you have to medication. He or she will tell you whether or not you can continue to take your medication as usual before the examination. In general, you can safely take aspirin and similar blood thinning medications before an examination, but it's always best to discuss their use with your doctor. Usually, essential medications can be taken on the procedure morning with only a small cup of water.
If you have an allergy to latex you should inform your doctor prior to your test. Patients with latex allergies often require a change of equipment and we must know before hand.
Do I need to take antibiotics?
Antibiotics aren't generally required before or after examinations. Tell your doctor if you take antibiotics before dental procedures. If your doctor feels you need antibiotics, antibiotics might be ordered during the examination or after the procedure to help prevent an infection. Again, tell your doctor about any allergies to medications.
Should I arrange for help after the examination?
You won't be allowed to drive after the procedure, even if you don't feel tired. You should arrange for an escort home. You should also plan to have someone stay with you at home after the examination, because the sedatives could affect your judgment and reflexes for the rest of the day.
What can I expect during enteroscopy?
For an examination of the upper gastrointestinal tract, your endoscopist might spray your throat with a local anesthetic before the test begins. You will receive sedatives intravenously to help you relax. You will most likely begin by lying on your left side. After you receive sedatives, your endoscopist will pass the scope through your mouth, esophagus and stomach into the duodenum and small bowel. The instrument does not interfere with your ability to breathe. The actual examination generally takes up to 60 minutes. Most patients consider it only slightly uncomfortable. The retrograde approach is similar to colonoscopy where the colon is examined and then the scope is inserted into the small bowel where progress is then made up the small bowel. This can be difficult and overall success may be only 80-90% as difficult loops and angles make upstream progress too difficult.
What happens after enteroscopy?
You will be monitored in the recovery area until most of the sedative medication's effects have worn off. If you had an upper procedure, your throat might be sore. You might feel bloated because of the air and water that were introduced during the examination. You'll be able to eat after you leave the procedure area, unless you're instructed otherwise.
Your doctor generally can inform you of the results of the procedure that day, but the results of some tests will take longer.
What are the possible complications of enteroscopy?
Although complications can occur, they are not common. The chances for any complication are less than 1%. The chances of a major complication are less than 0.5% or 1 in 200. For the oral approach you will have a sore throat for a day or more. Pain is unlikely and serious problems like pancreatitis or perforation will cause pain and should be reported to the doctor ASAP. In rare situations surgery may be required to repair a perforation. Other potential, but uncommon, risks of EUS include a reaction to the sedatives used; backwash of stomach contents into your lungs; infection; and complications from heart or lung diseases.
In recent years new resistant bugs can grow in these endoscopes and infections can be introduced into patients and these infectious can be very severe. Australian cleaning standards are high and cross infection is rare.