Endoscopy

Endoscopy of the small bowel has been termed the last frontier of flexible endoscopy. The usual diagnostic techniques applied to the small bowel are confounded by the small intestine’s length, its free intraperitoneal location, vigorous contractility, and overlying loops. These attributes limit the diagnostic ability of barium studies and limit the identification of specific sites by the special imaging techniques of nuclear medicine scans and angiography. The standard endoscopic examination of gastroscopy and colonoscopy view only limited areas of the small intestine. Upper endoscopy generally reaches the junction of the second and third portions of the duodenum and colonoscopy can intubate the terminal ileum for up to 30 cm. Endoscopic evaluation of the distal duodenum and large areas of the jejunum and ileum, deep in the small bowel, has been termed enteroscopy. Since 1973, there have been several attempts to develop technologies to allow easy and total small bowel intubation. Some techniques have survived such as push enteroscopy, while others—such as sonde enteroscopy, the rope-way technique, and the endostomy method—are no longer even remembered.