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Operator Qualifications

PowerSpiral Enteroscopy is a procedure requiring advanced skills. The operator must be credentialed in upper and lower endoscopy and should be specifically trained in this procedure following the Olympus training module for PowerSpiral Enteroscopy.

Indications

Patients requiring deep enteroscopy including:

  • Patients necessitating definitive diagnosis of small intestinal bleeding, polyposis, tumor, or inflammatory bowel diseases

  • Patients necessitating close examination and histopathological diagnosis of impaired digestive absorption, protein-losing enteropathy, or malabsorption syndrome

  • Patients necessitating endoscopic therapy of small bowel disease including polypectomy, hemostasis, dilatation, or foreign body removal

  • Patients necessitating evaluation of other suspected GI abnormalities such as; Crohn’s disease, ulcers, celiac disease, malabsorption, polyps, lymphoma, or other invasive diseases

Contraindications

Patients not suitable for a prolonged endoscopic procedure under general anesthesia or deep sedation, or general endotracheal intubation including: 

  • Patients with a medical instability preventing anesthesia

  • Non-consenting patients, or for patients where there has been a failure to gain consent

  • Patients with known perforation

  • Patients who have or have had uncontrolled coagulopathy

  • Patients who have had a recently placed feeding jejunostomy (e.g. less than two weeks)

  • Pediatric patients, especially infants and toddlers

  • Patients with a stent or other instruments implanted in the intestinal tract

Antegrade Approach

  • Perforated ulcer

  • Esophageal or gastric varices

  • Foregut stenosis

  • Deep mucosal laceration

  • Suspected or diagnosed eosinophilic esophagitis

  • Unable to accept mouthpiece

Retrograde Approach

  • Severe active inflammation of colon

  • Anal stenosis

  • Colonic stricture

Precautions

  • Known stricturing diseases such as Crohn’s disease or radiation enteritis

  • Pregnancy

  • Any prior abdominal or pelvic surgery including altered anatomy

  • Radiation enteritis

  • History of dysphagia or known esophageal swallowing disorders

  • Mild to moderate inflammation of colon

Pretreatment

Antegrade Approach

Patient should be fasting according to institutional anesthesia policy.

Retrograde Approach

The same pretreatment as that used for lower gastrointestinal endoscopy (colonoscopy), including a thorough bowel lavage.

Anesthesia

Either general anesthesia or deep sedation is recommended in all cases, and general anesthesia in particular for the antegrade approach. 

Patient Position

Antegrade Approach

 

  • The patient is positioned in the left lateral decubitus position with gentle neck extension. Other positions may be necessary.
  • The position of the patient can be altered during the procedure to facilitate enteroscope passage as needed.

Retrograde Approach

  • The patient is positioned in the left lateral decubitus or supine position.
  • The position of the patient can be altered during the procedure to facilitate enteroscope passage as needed.