CLINICAL-EVALUATION OF PUSH-TYPE ENTEROSCOPY

Background and Study Aims: Endoscopic exploration of the small bowel i s potentially of prime importance in studying gastrointestinal bleedin g of obscure origin, diarrhea and malabsorption, neoplasia, and other clinical conditions, but the method is still problematic because of th e limited efficacy of sonde-type enteroscopes. This study evaluates th e diagnostic yield of two push-type enteroscopes fitted with tip defle ction and a biopsy channel. Patients and Methods: Seventy-two consecut ive patients underwent enteroscopy using either an Olympus SIF-10 LY f iberscope or an Olympus SIF-100 video enteroscope. The depth of insert ion was always checked by fluoroscopy, and ranged 30-120 cm beyond the ligament of Treitz. Results: Angiodysplasia was identified as the sou rce in eight of 20 patients referred for gastrointestinal bleeding of obscure origin, and electrocoagulation was successfully performed in o ne case. A jejunal polyp was the cause of obscure bleeding in one pati ent. Radiological evidence of neoplasia/lymphoma located in the third portion of the duodenum or in the upper jejunum was ruled out in 10 of 12 patients. A normal jejunal appearance was found in two patients wi th lymphoma, subsequently confirmed by a normal enteroclysis. Duodenal or jejunal polyps were removed in seven of nine patients with familia l polyposis. Endoscopic and histological alterations were found in nin e of 24 patients with diarrhea or malabsorption. In addition, jejunal histology supplied the diagnosis in five patients with a normal endosc opic mucosal appearance. Only 18% of patients described slight, transi ent pain, and there were no complications. The tolerance and diagnosti c efficacy were the same with both instruments. Conclusions: Even thou gh push-type enteroscope exploration is restricted to the jejunum, the instruments are safe and efficacious in clinical practice, and permit in-depth study of small bowel anatomy and pathology.