Postoperative Adhesive Intestinal Obstructions

Balloon Abdomen Xray

Adhesive intestinal obstructions are a common pathological condition after surgery. Unlike strangulation bowel obstruction accompanying circulatory disturbance, adhesive intestinal obstructions often improve with conservative treatment such as fasting and fluid therapy. However, it recurs in many patients, and thus saline cathartics and Chinese herbal medicines are given prophylactically. In patients with recurrent adhesive intestinal obstructions, identifying the adhesions and dividing them...

General Considerations for Endoscopy

The double-balloon endoscope can be inserted through the mouth and the anus. Before insertion procedures specific for individual approaches are detailed, considerations common to both approaches are described. It is essential to provide the patient with adequate information on the examination and obtain informed consent before endoscopy. To relieve anxiety, the physician should inform the patient immediately before the examination that it takes more time than routine endoscopy but causes little...

Details of Informed Consent

The primary information provided during informed consent procedures should include the objectives, procedures, complications, and the patient's human rights. The reason the examination is to be performed should be clearly presented. It is necessary to describe the advantages of double-balloon endoscopy over other modalities. Double-balloon endoscopy allows relatively easy access to lesions located deep in the small intestine, which is not accessible with the conventional push method. It also...

Endoscopic Treatment of Small Intestinal Bleeding

Hemostatsis And Treatment

Various methods of endoscopic hemostasis have been developed for successful treatment of a variety of bleeding lesions in the gastrointestinal tract, including a peptic ulcer in the stomach and duodenum and angiodysplasia and diverticular hemorrhage in the large intestine. These successful endoscopic treatments obviate surgery in many patients, and endo-scopic hemostasis is one of the great achievements of therapeutic endoscopy. A variety of hemostatic techniques, including injection of ethanol...

Principle of Insertion of the Double Balloon Endoscope

Enteroscopy Double Balloon

In general, the most important factor when inserting an endoscope is to transmit the force applied to the endoscope shaft effectively to the endoscope tip. When the endoscope bends intricately or forms a loop, the force applied to the endoscope shaft is not transmitted to the endoscope tip, and thus the endoscope tip does not advance. When an enteroscope is inserted by the push method (the most commonly used technique for enteroscope insertion), the enteroscope may bend intricately or form a...

NSAIDInduced Small Intestinal Ulcer

Ileal Ulcer Symptoms

Allison et al. reported that autopsies revealed small-intestinal ulcers in 8.4 of patients receiving nonsteroidal antiinflammatory drugs (NSAIDs) for a long time 1 . In daily clinical practice, patients who are prescribed NSAIDs for relief of pain associated with rheumatic disease or arthropathy often have manifestations of melena and anemia of unknown cause. Many of these lesions are not accompanied by ulcers of the stomach, duodenum, large intestine, or terminal ileum that are accessible by...

What Is a Double Balloon Endoscope

The double-balloon endoscope is an endoscope that is used in a novel insertion method developed to ensure smooth insertion into the distal small intestine. Its principle came to my mind in 1997. I was involved in community health care after graduating from Jichi Medical University and was not familiar with endoscopic expertise, such as enteroscopy, until I went back to my alma mater 11 years after graduation. My thoughts resulted in a novel idea. In community health care settings, the lack of...

Retrieval of Dropped Hood

Foreign Body Retrieval Hood

Whereas a hood left caudal to the stenotic site is spontaneously excreted in the feces, a hood left proximal to the site may be retained in the gastrointestinal tract as a foreign body. Spontaneous excretion is unlikely, particularly when the dilatation is unsatisfactory. The hood should be retrieved after a series of interventions. It can be retrieved simply by reinserting the endoscope into the overtube that had been left in place, grasping the hood with a basket catheter FG-33W, Olympus...

Specific Tips for Insertion in Patients with a Postoperative Intestine

Balloon Dilation Intestine

Tube insertion, one of the tips for abdominal maneuvering is to apply pressure on regions so a redundant loop of the endoscope is reduced. The abdominal wall around the endoscope tip may be pressed or tapped, which allows the endoscope tip to advance. When a guidewire is used, care should be taken to avoid intestinal perforation by the guidewire. Thus, a soft-tipped guidewire is inserted and advanced through the forceps channel, followed by endoscope insertion. If the direction of the lumen is...

Crohns Disease

Ileal Ulcer Medicine

Crohn's disease consists of granulomatous inflammatory lesions with edema and ulcers and may occur in any part of the gastrointestinal tract from the mouth to the anus. In the small intestine, the ileum is preferentially affected. Endoscopic findings include a variety of ulcers, such as discontinuous or regional cobblestone appearance, longitudinal ulcers, aph-thoid ulcers, and irregular ulcers. In patients with long-standing disease, repeated fibrosis may result in intestinal stenosis....

Difficult Colonoscopy

Double Balloon Endoscopy

Total colonoscopy has become common practice, and it is less frequently difficult to complete a total colonoscopy by inserting an endoscope into the cecum. In some patients, however, even skilled endoscopists give up inserting the endoscope into the cecum because of its difficulty. As described in Chapter 5, what makes insertion of a colonoscope and other endoscopes difficult is the stretching of the intestine that has formed bends or loops. The endoscope tip does not advance because endoscope...

Intestinal Behgets Disease

Intestinalbehcet

Behcet's disease is a systemic inflammatory disease of unknown etiology with primary symptoms of recurrent oral aphtha, skin symptoms, eye symptoms, and vulval ulcers. The disease, accompanied by intestinal lesions, is called intestinal Behcet's disease. Common intestinal lesions include round or oval deep ulcers in the ileocecal region. In some cases, however, ulcerative lesions are not present in the ileocecal region but are present in other regions in the small intestine therefore,...

Representative Useful Therapeutic Devices for Use with EN450T5

Monopolar Apc

Resolution Clip 2261 Boston Scientific Fig. 11.1.7 and disposable Quick Clip HX-200U-135 Olympus Fig. 11.1.8 are available. Fig. 11.1.7. Resolution Clip 2261 Boston Scientific Fig. 11.1.7. Resolution Clip 2261 Boston Scientific Fig. 11.1.8. Quick Clip HX-200U-135 Olympus Fig. 11.1.8. Quick Clip HX-200U-135 Olympus 2. Argon plasma coagulation device. Argon plasma coagulation APC probes 20132179 and 20132-166 Erbe Fig. 11.1.9 are available, which are useful for coagulation of...

Manipulation in the Distal Small Intestine

Intestinal Balloon

The basic insertion technique for the distal small intestine is to advance the endoscope tip with minimum insertion force so the endoscope forms large concentric circles which are formed by stretching the mesentery in a fan shape around the fixed part of the mesentery on the retroperitoneum Figs. 8.5, 8.6 . As described above, the operator should avoid forcible insertion of a sharply angled endoscope. Reducing the angle as much as possible and swinging the tip allows effective insertion. The...

Overtube TS12140 TS13140

One is the TS-12140 outer diameter 12.2 mm, length 1450 mm for use with the EN-450P5, and the other is the TS-13140 outer diameter 13.2 mm, length 1450 mm for use with the EN-450T5. Both are flexible tubes. A latex balloon is mounted on the distal end of the overtube. Wetting the inner and outer surfaces of the overtube dramatically improves lubricity, which allows smooth insertion of a scope by reducing friction between the overtube and the scope and the...

Indications and Contraindications [3T1 Indications

Double-balloon endoscopy is indicated for enteroscopy in patients who have a suspected intestinal disease and require a thorough examination to determine the treatment strategy. It is also indicated in patients who have had a confirmed diagnosis of intestinal disease and in whom endoscopic treatment is required and feasible. In addition to problems of the small intestine, double-balloon endoscopy is also indicated for examination of the entire gastrointestinal tract, which is not accessible by...