6533b828fe1ef96bd12883b9

RESEARCH PRODUCT

Transvalvular enteroscopy using a mother-baby endoscope system: a new approach to the distal ileum.

subject

description

In the past decade various endoscopes have been developed to examine the small bowel, with two principal procedures established: sonde-type enteroscopy and push-type enteroscopy. The main indication is gastrointestinal bleeding of obscure origin. Push-type enteroscopy has proved itselfto be useful for the investigation ofdiseases of the small intestine. 1 The mean instrumental insertion length published by different working groups varied between 50 and 90 cm past the ligament of Trei tzfl 2 The small bowel examination area is limited to the jejunum. The alternative method is sonde-type enteroscopy that allows an insertion length of 140 (30 to 200) cm. 3, 4 Disadvantages of this type of enteroscopy are the lack of tip deflection capability and the lack of a working channel for therapeutic maneuvers. 5 Even after an examination period of about 6 hours the (proximal) ileum is reached in only 77% of patients. 4, 6 The distal ileum is hardly examinable by this technique; only one study group reports having reached the ileocecal valve in 10% of patients and the distal ileum in 40% of patients. 7 When using the per anal route, a s tandard colonoscope can be passed through the valve in 70% to 80% of patients, but the mean length of insertion is only about 10 (2 to 25) cm. s, 9 In conclusion, there exists a "no man's land" in the distal region of the ileum that can be reached only in a small proportion of patients. For these reasons we evaluated a mother-baby endoscope system for the per anal and transvalvular (through the ileocecal valve) visualization of the distal ileum.