| Theme | Patient Management During Endoscopic Examination and Treatment | |
|---|---|---|
| Title | Management for Therapeutic Enteroscopy | |
| Publish Date | 2012/09 | |
| Author | Kazuo Ohtsuka | Department of Endoscopic Diagnosis and Therapy, University Hospital of Medicine, Tokyo Medical and Dental University |
| Author | Noriyuki Ogata | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Seiko Hayashi | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Akihiro Araki | Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University |
| Author | Eriko Okada | Department of Endoscopic Diagnosis and Therapy, University Hospital of Medicine, Tokyo Medical and Dental University |
| Author | Shin-ei Kudo | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| [ Summary ] | Double-balloon endosocpy has made endoscopic therapy in the small intestine possible. Single balloon endoscopy has also been introduced and is used for treatment. Certain techniques are essential for therapeutic endoscopy. Confirming patient histories and comorbidity, precise diagnosis, requisite observation of indications, appropriate informed consent, and peri-operative management are also important. There are sometimes difficulties for reaching the scope to lesions in the small intestine. Re-examination or secondlook is challenging. More precise procedures are required to provide improved therapeutic enteroscopy. Sedation for this procedure is essential, especially for antegrade insertion and conscious sedation is preferable. Oxygen concentrations, pulse and blood pressure should be monitored during these procedures. An emergency cart should also be readily available. Carbon dioxide insufflation creates lowered pressures in the lumen and is useful not only for insertion but for safe therapy. Important possible adverse events include perforation and bleeding. Avoidance of perforations, the presence of stenoses with deep ulceration or extreme bending are contraindications for endoscopic therapy. Pancreatitis and pneumonia are important complications associated with antegrade insertion. Lengthy procedures may lead to those events. Therapeutic enteroscopy is effective and safe, however, cautious procedures must be employed. | |