EnteroscopyEdit
Enteroscopy refers to the use of specialized endoscopic instruments to visualize, biopsy, and treat disease within the small intestine. This segment of the gastrointestinal tract has historically been difficult to access with standard endoscopy, but advances in enteroscopy have given clinicians a practical way to directly inspect deep portions of the small bowel. While capsule endoscopy can survey mucosal lining noninvasively, enteroscopy provides the crucial ability to take biopsies, dilate strictures, and perform targeted therapies when a lesion is found. The field has evolved through the development of instrumented techniques that use overtubes and balloons or other devices to advance the endoscope through winding loops of small intestine, allowing both diagnostic and therapeutic work in centers with specialized expertise. endoscope technology, together with experience and proper patient selection, has expanded the set of tools available to manage small-bowel disorders.
In clinical practice, enteroscopy is frequently compared to capsule endoscopy and traditional endoscopic approaches. Capsule endoscopy offers a noninvasive survey of the small intestine but cannot obtain biopsies or perform therapy; enteroscopy fills that gap by enabling tissue diagnosis and intervention. Consequently, enteroscopy is typically reserved for cases where noninvasive imaging suggests pathology or when there is a need for definitive management of small-bowel conditions. For a broader contrast, see also Capsule endoscopy and Gastrointestinal endoscopy.
Techniques and equipment
Device-assisted enteroscopy
The most widely used forms of device-assisted enteroscopy employ overtubes and balloons to anchor and pleat the small intestine, allowing the endoscope to be advanced beyond the reach of conventional enteroscopy. The two most common approaches are double-balloon enteroscopy (DBE) and single-balloon enteroscopy (SBE). In these procedures, an enteroscope works in tandem with an overtube, and the sequential inflation and deflation of balloons help to stabilize and lengthen the small bowel for examination and intervention. Other techniques, including spiral enteroscopy, have been developed to achieve similar goals with different mechanical strategies. See Double-balloon enteroscopy and Single-balloon enteroscopy for detailed methodologic descriptions, and spiral enteroscopy for an alternative approach.
Peroral versus retrograde access
Enteroscopy can be performed by advancing the device through the mouth (peroral) to examine the upper small intestine, or through the anus (retrograde) to access the distal segments. In some cases, both approaches are used in a single session to obtain a complete study of the small bowel. The choice of route depends on the suspected location of disease, prior surgeries, and the patient’s anatomy.
Therapeutic capabilities
Beyond visualization and biopsy, enteroscopy supports a range of therapeutic tasks. Dilation of tight strictures, extraction of foreign bodies, hemostasis of bleeding lesions, and ablation of mucosal abnormalities can be performed during a single session, potentially avoiding surgical intervention in selected patients. See therapeutic endoscopy for a broader discussion of endoscopic therapy.
Anesthesia and safety considerations
Because these procedures can be lengthy and technically demanding, anesthesia or monitored sedation is commonly used to optimize patient comfort and safety. Practitioners monitor for complications such as perforation or pancreatitis, and patient selection plus center experience play critical roles in minimizing risk. See Anesthesia and Perforation (medicine) for related topics.
Indications and clinical use
Obscure gastrointestinal bleeding
One of the primary indications for enteroscopy is obscure gastrointestinal bleeding (OGIB), where initial endoscopy and imaging fail to identify the source. Device-assisted enteroscopy can localize bleeding sites, enable targeted biopsies, and allow therapeutic interventions such as clipping, coagulation, or argon plasma coagulation. See Obscure gastrointestinal bleeding for a broader discussion of this clinical problem.
Inflammatory and malabsorptive diseases
Enteroscopy is valuable in evaluating suspected Crohn’s disease and other inflammatory conditions of the small intestine when noninvasive tests are inconclusive. It also helps diagnose small-bowel tumors, polyps, and other lesions that may be missed by standard imaging. See Crohn's disease and Small intestine for related topics.
Therapeutic interventions
In addition to diagnosing disease, enteroscopy enables interventions such as dilation of strictures, removal of intraluminal foreign bodies, and targeted therapy of bleeding lesions, often in patients who would otherwise require surgical management. See Endoscopic therapy for a broader framework of therapeutic endoscopy.
Outcomes, safety, and limitations
Diagnostic and therapeutic yield
In experienced centers, the diagnostic yield of device-assisted enteroscopy for OGIB and other small-bowel indications is typically reported in the range of the high tens to around seventy percent, with higher yields when a focused clinical question is present. Therapeutic yield—meaning the procedure achieves a clinically meaningful treatment—varies by lesion type and expertise but can be substantial when stricture dilation or endoscopic hemostasis is feasible. Robust data come from multiple studies and practice guidelines; see Obscure gastrointestinal bleeding and Therapeutic endoscopy for summaries.
Complications
Adverse events are uncommon but real risks include perforation, pancreatitis (in certain procedural contexts), bleeding, and cardiopulmonary reactions to anesthesia or sedation. The risk profile generally improves with high-volume centers and standardized protocols. See Perforation (medicine) and Complications of endoscopy for context on procedure-related risks.
Comparisons with other modalities
Capsule endoscopy remains a noninvasive survey tool but lacks biopsy and therapy. Standard endoscopy cannot access most of the small intestine at depth. Enteroscopy thus occupies a niche where visualization, biopsy, and treatment are required beyond the reach of conventional methods. See Capsule endoscopy and Endoscopy for related modalities.
Economic and policy considerations
From a policy and practice standpoint, the adoption of enteroscopy technologies is tempered by cost, training, and laboratory infrastructure. The devices and disposables required for device-assisted enteroscopy add to procedural costs, and not all facilities have the volume or expertise to maintain proficiency. Proponents argue that enteroscopy can reduce downstream costs by preventing unnecessary surgery, shortening hospital stays, and enabling definitive therapy in a single session when performed at high-volume centers. Critics emphasize the need for clear, guideline-driven indications and robust evidence of cost-effectiveness in varied healthcare settings, to avoid overuse or misallocation of resources. In discussions about optimization of care, factors such as patient selection, operator experience, and regional access to specialized centers frequently drive policy decisions and reimbursement frameworks. See Health economics and Healthcare policy for broader context.
Contemporary debates sometimes surface around how much emphasis should be placed on advanced technologies versus conservative pathways and patient-centered decision-making. Critics who prioritize broad access and equity may argue for caution with expensive, highly specialized procedures; supporters counter that targeted use in appropriate patients yields meaningful benefits and can align with value-based care objectives. In practice, the best outcomes tend to occur where clinical guidelines are complemented by physician judgment, high-volume expertise, and transparent discussion with patients about risks, benefits, and alternatives. See Value-based care for a related concept.