Diagnostic yield of deep enteroscopy techniques for small-bowel bleeding and tumors

Endoscopic evaluation and management with deep enteroscopy techniques have largely replaced the role of intraoperative enteroscopy in the management of small-bowel (SB) disorders. While capsule endoscopy (CE) enables visualization of the entire SB, therapeutic deep enteroscopy techniques (balloon-assisted enteroscopy and spiral enteroscopy) facilitate diagnostic and therapeutic management deep within the SB. CE is currently recommended as the third test of choice in the evaluation of obscure gastrointestinal bleeding after a negative bidirectional endoscopy. The test also has a role in the diagnosis of SB tumors and surveillance of familial polyposis syndromes. Therapeutic deep enteroscopy techniques are mainly used for evaluation and management of CE findings, but they may also have a role in patients with a negative CE but high clinical suspicion for an SB disorder. Because preliminary data suggest a comparable diagnostic and therapeutic yield with double-balloon, single-balloon, and spiral enteroscopy, selection of the enteroscope should be based on availability and the endoscopist's experience with the technique.