Small Bowel Enteroscopy

Abstract

Technologic advancements in visualization of the small bowel with wireless capsule endoscopy (WCE) (Given Imaging Ltd., Yoqneam, Israel) and the double-balloon electronic enteroscopy system (Fujiron, Japan) have created an excitement and thirst for additional knowledge of the small bowel. We now have the means to diagnose and possibly endoscopically obtain histology and treat these maladies, which heretofore has been possible only in the surgical realm. Bleeding is not boccultQ but originates from the small bowel. We have learned through these two new technologies that small bowel radiology will go the way of full column barium enema, which is used only to obtain information about luminal patency or in circumstances that preclude endoscopic advancement. Sources of bleeding have been identified earlier, which has resulted in our ultimate goal: improved patient quality of life. Visualization of early changes of disease has changed our understanding of their natural history. Small bowel tumors initially present with bleeding, not obstruction, and approximately two thirds are malignant. Celiac disease is much more common than we had realized and has a wide spectrum of presentations. It may be complicated by ulcers, strictures, and tumors. WCE allows for its diagnosis as well as diagnose its complications. WCE has a multiplicity of roles in patients with suspected or known Crohn’s disease. It allows the explanation of symptoms in patients with negative radiological studies, may make a diagnosis in patients with intermediate colitis, and established that Crohn’s disease is the cause of iron deficiency anemia in a patient who is otherwise asymptomatic. Gastrointest Endoscopy Clin N Am