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Small Bowel Endoscopy

BALLOON-ASSISTED ENTEROSCOPY

 

What is a balloon-assisted enteroscopy?

Until recently it was difficult for doctors to examine very far into the small intestine. A new type of endoscope called a balloon-assisted enteroscope now means it is possible to examine much further into the small intestine and in some cases offer treatment this way.

A balloon enteroscope enables the endoscopist to:

·        Visualise the entire small bowel

·        Remove tissue for histology (biopsy)

·        Remove abnormal growths e.g. polyps

·        Treat bleeding problems

·        Dilate strictures

 

Preparation at home

If you take aspirin, warfarin and other blood-thinning medicines you may need to discontinue these and should consult your doctor (GP or Dr Maiden) as to when you should stop taking them. If you are on iron supplements (eg. ferrous sulphate) please stop taking this 1 week before the examination. For this examination to be successful and allow a clear view of your small bowel, it must be empty as possible. On the day before the examination you may have breakfast and a light lunch (such as soup, pasta, white meat, but avoid salad, vegetables, nuts and grains). From then on consume only clear fluids (including consommé soup, juices etc.) until you go to bed. On the morning of the examination you may have small sips of water only. You can continue to take all your medicines as normal but these should be taken before 8am. Have nothing to drink from 4 hours before the time of your procedure.

 

What does the examination involve?

You will be given a sedative and analgesia. This is administered through a needle placed in your arm or hand to help you feel more relaxed. It may induce sleep after the procedure. You will be asked to remove spectacles and dentures. A device which monitors your heart rate and breathing will be attached to your finger. While you are lying on your left, a small mouth piece will be placed in your mouth to protect your teeth and gums. Dr Maiden will gently insert an enteroscope through your mouth into your stomach. This is not painful and will not make breathing or swallowing difficult. However you may experience some retching and feel a little uncomfortable. Gentle, slow breaths through your mouth help to alleviate and settle this. Sometimes you will be given oxygen. Your stomach will be gently inflated with air to expand it thus enabling the lining to be seen more clearly. The air is sucked out at the end of the procedure. It may be necessary for the nurse to clear saliva from your mouth using a small suction tube. The examination may take anything from 5 to 20 minutes, depending on how far into your small bowel Dr Maiden inserts the enteroscope. Afterwards the enteroscope is gently removed.

 

 After the examination

 You will be taken to the recovery area in order to rest. The nursing staff will advise you when you can go home.

 If you have the sedative injection you must:

·        have a responsible relative or friend with a car (not public transport) to take you home and stay with you for at least 12 hours.

·        You must not drive, drink alcohol, operate machinery or sign important documents for 24 hours following the test.

You may experience a mild sore throat but this will pass and is nothing to worry about. You may feel a little bloated from some air that can remain in the stomach. Again, this will pass and is nothing to worry about. You may eat and drink as normal.

 

 

Are there any risks?

This is a safe procedure and complications are rare but include:

·        Bleeding after biopsy or removal of a growth (or polyp). This is usually minimal and stops quickly or can be controlled.

·        The endoscope can cause a tear or hole in the tissue being examined, which is a serious but rare problem (<1 in 3,000), and may subsequently require surgery to repair it.

·        Adverse reactions to medications used in the sedation are possible. You will be carefully monitored throughout the examination by trained nursing staff.


What are the alternatives?

The other tests to look at the small bowel include radiology (barium studies, CT or MRI scan) or capsule endoscopy but these could not offer any treatment at the same time. An endoscopy may reach the first part of your small bowel but not all of it. You can discuss your concerns with Dr Maiden or your GP before coming for the test. You can also decide not to have the test, if so please discuss this with Dr Maiden