Enteroscopy is the examination of the small bowel with a fiberoptic endoscope that is passed down the esophagus, through the stomach, through the distal duodenum, and then into the jejunum. Once in the jejunum, the endoscopist uses a series of movements to advance the endoscope as far as possible. A device known as an overtube may be applied to the endoscope to prevent it from looping in the stomach and inhibiting deep intubation of the small intestine. Fluoroscopy may also be useful in determining the position of the endoscope in the small bowel.

Virtual enteroscopy uses an ingested video capsule to aid in the diagnosis of small bowel abnormalities. The video capsule is a wireless virtual endoscope that transmits video images as it travels through the bowel.

The main indication for enteroscopy is unexplained GI bleeding. It may also be used to help ­diagnose patients with unexplained chronic diarrhea or suspicious x-ray findings. It is very useful in diagnosing a small bowel abnormality out of reach of a standard endoscope that might otherwise be done surgically.

1. This examination is usually performed in an outpatient setting of a hospital or ambulatory clinic. It also may be performed in the operating room or in a critical care setting.

2. Use a topical spray to anesthetize the patient’s throat.

3. Start an IV line and use for administration of sedation alone or in combination with analgesic agents. These medications are given to achieve a state of conscious sedation. Resuscitation ­equipment must be available.

4. Perform continuous monitoring of the patient’s vital signs, cardiac rhythm, and oxygen saturation (via pulse oximetry).

5. Remove partial dental plates or dentures. Insert a mouthpiece to prevent the patient from biting the endoscope and to prevent injury to the patient’s teeth, tongue, or other oral structures.

6. Depending on the endoscopist’s preference, an overtube may be back-loaded onto the endoscope. The endoscope is well lubricated and gently inserted through the mouthpiece into the esophagus and advanced into the stomach and duodenum. To advance into the distal duodenum and jejunum, the endoscopist may use a series of pushing and pulling movements that serve to pleat the small bowel onto the endoscope, allowing deeper intubation. Fluoroscopy is useful to determine location in the small bowel.

7. Obtain biopsy specimens and brushing for cytology. Take photos to provide a permanent record of observations.

8. Inform the patient that they may initially have a strong gagging or choking sensation. During the procedure, the patient may belch frequently and have a sensation of abdominal pressure and bloating.

9. Immediately after the procedure, have the patient remain on the left side until fully awake.

10. If virtual enteroscopy is being performed, the patient will swallow a small video capsule (size of a large pill). As the video capsule travels through the GI tract, due to normal peristalsis, images are transmitted to a recorder and subsequently reviewed.

Abnormal results may indicate the following:

1. Vascular abnormalities, such as angiodysplasia or varices

2. Ulcerative lesions, such as in inflammatory bowel disease

3. Diverticula such as Meckel diverticulum (congenital defect in the lower part of the small intestine resulting in an outpocketing of tissue)

4. Tumors

Pretest Patient Care

1. Explain the purpose and procedure of the examination, the sensations that may be experienced, and the benefits and risks of the test. Refer to the conscious sedation and analgesia precautions in Chapter 1.

2. Inform the patient that the procedure may be several hours long, depending on the ease of passing the endoscope, diagnosis, and treatment.

3. Inform the patient that they will be sleepy during the test and may not recall much of the experience.

4. Confirm that the patient has fasted for 10–12 hours before the procedure to avoid the risks for aspiration and possible cancellation of the procedure.

5. Confirm that an informed consent is signed and witnessed and in the patient’s medical record before the procedure.

6. Encourage the patient to urinate and defecate if possible before the examination.

7. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Normal

• Small intestinal tract within normal limits