Do we need the overtube for push-enteroscopy?

Background and Aims: Push-enteroscopy is well established in many gastroenterological departments. There is no agreement about whether the use of an overtube is helpful to optimize the depth of insertion. In this prospective and randomized study we investigated the effect of the overtube for push-type enteroscopy. Patients and Methods: Between August 1999 and August 2000, 80 patients (47 male, 33 female; age 63.1, range 20-90 years), who underwent investigation by push-enteroscopy were randomly allocated to two groups. Group T underwent investigation with the Olympus push-enteroscope SIF 100 with an overtube and group NT without an overtube. The length of insertion was estimated by fluoroscopy, by counting the folds of the small bowel and by insertion length in centimeters, while the scope was drawn back to the pylorus. The number of pathological findings was documented and patient comfort was measured by means of a standard questionnaire completed after enteroscopy. Results: Both groups were comparable with regard to age, gender, indication for enteroscopy and pathological findings. There was a highly significant correlation between the length of insertion measured in centimeters and the counted folds in both groups (correlation 0.57, P <0.001 in group T; 0.80, P <0.001 in group NT). The length of insertion estimated by means of fluoroscopy was not reliable in determination of the exact length of insertion. There was a significant difference (P <0.05) in the insertion depth between group T (mean values: insertion length 72.4 cm, counted folds 99.3) and group NT (mean values: insertion length 60.8 cm, counted folds 74.1). Conclusions: The use of an overtube in push-enteroscopy is advantageous with respect to the depth of insertion (significant difference between group T and NT in counted folds and the insertion depth in centimeters). At this time, this gain of insertion length did not result in a higher rate of pathological findings. Nevertheless, we would recommend the use of an overtube in performing push-type enteroscopy in order to increase the number of pathological findings.