Going to Where No One Went Before: Endoscopic Procedures of the Small Bowel

Abstract

Diagnostic and therapeutic endoscopic procedures of the small-bowel have for a long time been a great challenge to gastroenterologists. Especially the anatomy of the small intestine in combination with the lack of adequate, non-invasive, diagnostic tools, made it an almost ‘no-go’zone. Only in selected cases push enteroscopy and intraoperative enteroscopy were performed. Push enteroscopy has both diagnostic and therapeutic capabilities, but typically only examines a limited part of the proximal small bowel. Intraoperative enteroscopy permits examination of the entire small bowel and therapeutic interventions, but is much more invasive. The need for endoscopic access to improve diagnosis and treatment of small bowel disease has led to the development of novel endoscopic technologies. In 2000 the diagnostic and non-invasive video capsule endoscopy was introduced, followed by the more invasive double-balloon enteroscopy system in 2001, the latter combining diagnostic and therapeutic capabilities. The following years, single balloon enteroscopy and spiral enteroscopy were introduced as alternatives for double balloon enteroscopy, with in theory, comparable diagnostic and therapeutic capabilities. Complete enteroscopy of the small bowel is now in reach: ‘easy’ and much less invasive, and can be performed world wide in any endoscopy unit.