SMALL-BOWEL ENTEROSCOPY IN 1991 - THE END OF THE TUNNEL

Small bowel enteroscopy in 1991 is now feasable in two clinical situations: in the case of malabsorption or diffuse intestinal disease, it is easier to visualise the small bowel with the <<push enteroscopy method>>. The most proximal and distal ends of the small intestine can be viewed through standard instruments or better with videocoloscope beyond the ligament of Treitz. The ileocecal valve can be intubated after total colonoscopy for the evaluation of Crohn's disease, tuberculosis and small bowel lymphoma. In the case of occult gastrointestinal hemorrhage small bowel enteroscopy now permits visualization of large amounts of small intestinal. When the gastrointestinal bleeding is severe, we recommend intraoperative enteroscopy. When the bleeding is not severe and chronic, it is possible to perform a non surgical total small bowel enteroscopy with an enteroscope or videoenteroscopoe. Prototypes are under development. The procedure is safe an can be performed on an outpatient basis. The limitations of the procedure are the impossibility of intervention and inability to inspect the total mucosal surface. It is not a <<first line>> or <<second line>> investigation in these situations. It should be considered after previous investigations have been negative. Push enteroscopy should be performed by general endoscopists, non surgical and total enteroscopy should be reserved, for instance for skilles and motivated team endoscopists.