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.
- Content Type
