Manipulation in the Distal Small Intestine

Double Balloon Enteroscopy

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...

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...

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...