CONTENTS

1.0 Introduction

2.0 Formulation of guidelines

2.1 Grading of recommendations

2.2 Scheduled review

3.0 Summary of recommendations

4.0 Types of small bowel enteroscopy

4.1 Enteroscopy using a colonoscope

4.2 Sonde enteroscopy

4.3 Push enteroscopy

4.4 Intraoperative enteroscopy

4.5 Double balloon (push and pull) enteroscopy

5.0 Capsule endoscopy

5.1. Technique

5.2 Indications for capsule endoscopy

5.3 Complications of capsule endoscopy

5.4 Patency capsule

6.0 Service provision and training

References

1.0 INTRODUCTION

The small bowel has historically been a difficult area to examine due to its anatomy, location and relative tortuosity. Examination beyond the duodenojejunal flexure is of importance in a number of small bowel disorders. Before the advent of enteroscopy or capsule endoscopy, radiographic studies had been the main investigative modality of the small bowel. Barium follow-through and enteroclysis permits indirect examination of the small bowel but has a low diagnostic yield particularly in the context of obscure gastrointestinal bleeding.1^–3

Capsule endoscopy and enteroscopy are now the preferred methods to examine the small bowel in most situations. These guidelines are intended to provide an evidence based document describing endoscopic investigation of small bowel disorders.

2.0 FORMULATION OF GUIDELINES

These guidelines were commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG) and have been produced by the small bowel and endoscopy sections of the BSG. The guidelines have been produced to conform to the North of England evidence based guidelines development project.4 5 They have been drawn up from a Medline, Embase and Ovid literature search using terms “enteroscopy”, “push enteroscopy”, “intraoperative enteroscopy”, “double balloon enteroscopy” and “capsule endoscopy”. There have been 180 peer review studies, seven review articles, 58 case reports and letters, and one set of American guidelines on enteroscopy.6 The literature search for capsule endoscopy includes 100 peer review studies, 51 review articles, 74 …