What Is Small Bowel Enteroscopy?

An enteroscopy (also called a push enteroscopy) is a medical test that is used to examine the inside of the small bowel. It is a type of endoscopy procedure that may be used to diagnose and treat several types of digestive conditions, such as small bowel tumors, polyps, gastrointestinal bleeding, and small bowel diseases.

The procedure allows a physician to find and treat problems in the digestive tract without surgery. It calls for a long, flexible tube with a camera on the end to be inserted through the mouth and into the upper gastrointestinal tract. The camera's range is considerable, including the lining of the esophagus, stomach, duodenum (first portion of the small bowel) and jejunum (the middle portion of the small bowel). 

This article explains the purpose of an enteroscopy as well as the risks. It also outlines what you can expect before, during, and after the procedure.

Purpose of Test

A surgeon, gastroenterologist, or other trained healthcare professional can perform an enteroscopy. The procedure is done using an endoscope, which is a long, flexible tube with a camera on the end. The tool is inserted through the patient's mouth and down the esophagus.

The endoscope allows the healthcare professional to see the inside of the digestive tract, including the stomach and small intestine, and take one or more small pieces of tissue for study (a biopsy). In addition, because the small intestine is being accessed, it may be possible to administer therapy, such as removing a polyp (a growth).

An enteroscopy may be ordered after other tests (such as colonoscopy, X-ray, or barium swallow) show that there could be a problem in the digestive system. Sometimes, these tests fail to reveal a reason for a symptom (such as bleeding). The enteroscopy serves as the next step.

Some of the signs and symptoms that may prompt a healthcare professional to order an enteroscopy include:

• Bleeding in the digestive tract
• Nausea and vomiting
• Persistent heartburn
• Radiation treatment damage
• Stomach pain
• Unexplained weight loss
• Bowel obstruction
• Crohn's disease
• Malnutrition
• Severe diarrhea
• Suspected or confirmed tumor

Types of Enteroscopy

A healthcare professional may use one of three techniques to perform an enteroscopy:

• A double-balloon enteroscopy, in which the tube with the camera is placed inside a wider tube. Both tubes have a balloon on one end. They are used during the test to anchor the endoscope in the digestive tract. The provider can inflate and deflate the balloons as they probe the small intestine, one section at a time.
• A single-balloon enteroscopy, in which only one balloon is used
• A spiral enteroscopy, which relies on a rotating spiral placed over the endoscope to move within the small intestine. As the newest of the three techniques, it was designed to provide a simpler, faster alternative to the balloon techniques.
  

Risks and Contraindications

An enteroscopy is a safe outpatient procedure, but it might not be recommended for certain people, like those who are pregnant, obese, or have lung or heart disease. The test is done under sedation or anesthesia, so it may not be recommended for those who have had a bad reaction to either medicine in the past or who may be adversely affected because of another disease or condition.

There are some adverse effects that may occur after the test. They should go away in a day or two but can include:

• Abdominal bloating
• Nausea
• Sore throat

The rate of complications after enteroscopy is estimated to be extremely low, or about 0.9%. Some of the complications that could occur include inflammation of the pancreas (pancreatitis), bleeding, and a perforation (hole) in the small intestine.

Before the Test

Your healthcare provider will provide instructions about how to prepare for the test. You may have to stop taking certain medications for a time, including anything that’s taken over the counter, such as Pepto Bismol and iron supplements. Any drugs that thin the blood, including non-steroidal anti-inflammatories such as aspirin, may be off-limits for a week or more before the test because they can increase the risk of bleeding.

Understandably, many patients have questions about the procedure. Their queries often include:

• Where are these procedures usually performed? As an outpatient procedure, an enteroscopy usually takes place in a hospital, surgical center, or endoscopy center.
• What should I wear? Choose loose, comfortable clothing since you'll be asked to change into a hospital gown. Leave any expensive jewelry at home.
• What can I eat and drink beforehand? The test works best when the stomach and small intestine are empty. It's common for solid foods to be banned after midnight the day before the test, with clear liquids stopped six hours beforehand. Check with your provider to be certain, though; their rules may differ.
• Should I bring anything with me? It's most important to bring a friend or family member to drive you home after the procedure. You can expect to feel groggy afterwards. (Your companion can also hold onto your phone while the procedure is underway.)

Reach out to your healthcare provider if you have other questions about how to prepare for the procedure.

During the Test

After you arrive at the hospital or surgical center, the staff will tell you exactly what they expect you to do. As seasoned professionals who have probably managed the process hundreds of times before, they likely have addressed every issue or concern under the sun. So don't be shy—and try not to be nervous.

The enteroscopy will be performed by a physician, but other medical professionals who will assist may include nurses, a nurse anesthetist, and an anesthesiologist.

Pre-Test

Checking in for a medical test usually means providing the front office staff with an insurance card and a form of identification (such as a driver’s license). Every institution has slightly different processes, but in general, there will be forms to read and sign that pertain to the test. This includes a consent form.

You will be called back into the prep and recovery area to get ready for the test. It will be necessary to change into a hospital gown and put your street clothes into a bag or perhaps a locker. A nurse or other staff member will ask a list of standard questions about what you've ingested over the last 24 hours and how you plan to get home.

A nurse will set you up in a hospital bed and an intravenous line (IV) will be inserted in a vein to administer fluids and sedatives. Monitoring devices may also be used, such as a blood pressure cuff and a heart monitor, to keep track of your vital signs during the test. When it’s time for your test to begin, the bed will be wheeled into the endoscopy suite, where the test will take place.

Throughout the Test

You will be hooked up to a sedating machine that will deliver medicine to either make you very relaxed or put you to sleep. Then the physician will insert the endoscope into your mouth and slowly move it down into the small intestine. As uncomfortable as this may sound, it's unlikely you will feel anything more than slight pressure or fullness.

Post-Test

After the test is over, you will be taken back to a room to fully wake up and recover somewhat before you're released to go home. Your physician may come by to discuss the initial results of the enteroscopy, depending on how you feel.

Count on scheduling a follow-up appointment to go over the results in greater detail.

After the Test

Nurses will remove your IV and probably offer you something to drink, such as water, ginger ale, or cranberry juice. You may stay in the recovery area for a few hours following the procedure.

They will give you instructions to follow once you're home. But in general, it’s recommended to rest and take it easy for the remainder of the day.

Most people are able to eat soft foods later the same day. It largely depends on their appetite. You may be advised to stay away from spicy or fatty foods for the rest of the day to keep your stomach in a calm state.

Managing Side Effects

You may find a small amount of blood in your stool after the enteroscopy. More likely, you will feel bloated. These are normal side effects and nothing to worry about. However, you should call your healthcare provider right away if you experience:

• Black stools
• Fever
• Increasing abdominal, chest, or throat pain
• Bleeding
• Trouble swallowing
  

Interpreting Results

Your healthcare provider may have some initial results to share with you immediately after the test, so it’s a good idea to have that friend or family member listen alongside you to absorb any important information and ask questions.

If there was a need for a biopsy, the results may take several days. In the meantime, try to relax—and remember that your medical team is there to support you.

Summary

An enteroscopy allows a physician to find and treat problems in the digestive tract without a patient having to undergo surgery. It calls for a long, flexible tube with a camera on the end to be inserted through the mouth and into the upper gastrointestinal tract.

An enteroscopy can either confirm a presumed diagnosis or point to reasons why a patient may be experiencing symptoms like bleeding, nausea or vomiting, persistent heartburn, severe diarrhea, stomach pain, or unexplained weight loss. An enteroscopy is a common, low-risk procedure but may cause minor side effects such as cramps, bloating, and sore throat.

A Word From Verywell

It may help to remember that an enteroscopy excels at what many healthcare providers only dreamed about 20 years ago: giving them a close-up view of the stomach and small intestine. For many people, an enteroscopy represents the first step in learning the cause of their stomach distress—and what they can do to begin a new and healthier chapter in their lives.