Enteroscopy

It is now more than 25 years since small bowel enteroscopy (SBE) was first described. For several reasons, this technique developed more slowly than other more usual forms of endoscopy. First, small bowel disease is relatively rare in comparison with other gastrointestinal diseases. Also, there was lack of initial design agreement, and three different types of enteroscopes were developed within a short time of each other, two of which (push-type and sonde) are now available commercially. Finally, commercial interests of the manufacturers of endoscopes were mainly focused on the more conventional, large volume markets. In the last few years, specifically designed modern small bowel enteroscopes have become available and, in centers that have access to them, they have superseded attempts at SBE using adult or pediatric colonoscopes. There are now clear indications for SBE, such as: the investigation of obscure causes of bleeding and anemia; malabsorption; clarification of x-ray abnormalities; and, increasingly, the application of therapeutic endoscopy to lesions within the small bowel. Problem areas remain, but with advancing technology and more professional interest in this area, these will be addressed during the next few years.