Small Bowel Endoscopy

Abstract

Currently, we have two balloon-assisted enteroscopy (BAE) systems to observe the entire small bowel. One is double balloon enteroscopy (Fujifilm Medical Co., Tokyo, Japan) that Dr. Yamamoto developed, and the other one is single balloon enteroscopy (Olympus Co., Tokyo, Japan). Both of them enable the endoscopist not only to observe the small bowel directly but also to perform the endoscopic treatments in the small bowel. This new modality led us to obtain much knowledge about small bowel diseases. BAE has some advantages, including the ability of directly observing the small bowel and performing biopsy, compared with other small bowel modalities. CT and MRI are the least invasive methods; however, these methods are not able to evaluate the small bowel mucosal lesions directly or in detail. Capsule endoscopy (CE) is also a noninvasive method, and it can directly observe the small bowel mucosa. Therefore, this modality has been frequently used for evaluating small bowel disorders in the world. However, it has several limitations including the possibility of retention in case of intestinal strictures and impossibility of the biopsy. On the other hand, the biopsy can be done easily by using the BAE. BAE is quite useful for the correct diagnosis of small bowel diseases, particularly small bowel tumors and inflammatory diseases. However, BAE also has some disadvantages in terms of its invasiveness and technical difficulty of insertion. We should select the best one among these modalities for small bowel observation according to the status, indication, purpose, and suspicious diagnosis of each case.