DIAGNOSTIC ACID THERAPEUTIC PUSH TYPE ENTEROSCOPY IN CLINICAL USE

This study describes small bowel push enteroscopy in routine clinical practice, using a purpose designed instrument (Olympus SIF-10). Fifty six patients had a total of 60 procedures over a two and a half year p eriod. The median (range) depth of small intestine intubated was 45 (1 5-90) cm. Procedure time varied from 10-45 minutes. Most enteroscopies were performed during routine gastroscopy lists. The technique was co mparatively easy for experienced endoscopists to learn. Forty two proc edures were for diagnostic purposes. Eleven patients had gastrointesti nal bleeding where the source was obscure, or where early investigatio ns had suggested a small bowel source: a specific diagnosis was made i n 45% of these cases. Of seven iron deficient anaemic patients using n on-steroidal anti-inflammatory drugs (NSAIDs), only one had a lesion d etected in the upper small bowel. Nine patients had abnormal small bow el barium studies. Small bowel abnormalities were seen in six cases an d were definitively diagnostic in three of these; in three patients th e barium study appearances were confirmed as artefact. Fifteen patient s were investigated for abdominal symptoms suggesting small bowel obst ruction or malabsorption: a diagnosis was made in five cases. Fifteen patients underwent enteroscopy for therapeutic purposes, including suc cessful treatment of difficult enteral feeding problems by nasojejunal tribes or by cutaneous endoscopic jejunostomies, polypectomy for Peut z-Jeghers syndrome, and dilatation of strictures. Additionally, bleedi ng lesions detected in patients during investigation of anaemia were s uccessfully treated at the time by YAG laser or bipolar diathermy. In conclusion, push enteroscopy is a practical and valuable clinical serv ice, which should probably become available on a subregional basis.