Push Endoscopy

1 What is a Push Endoscopy?

Push endoscopy (also called push enteroscopy) is a procedure during which the upper small intestine can be diagnosed and treated for diseases.

The endoscope is similar as in standard endoscopy but with a length of 200 cm, and after it is passed into the duodenum, a more rigid overtube is passed over the endoscope to straighten its path so the endoscope then can be advanced without coiling in the stomach.

This procedure is useful for examining and delivering therapy in the small intestine like in patients with intermittently bleeding angiodysplasias (clusters of weakened blood vessels) located in the small intestine beyond the reach of a standard upper endoscope, because push endoscopy can be helpful in both diagnosing the bleeding site as well as in stopping the bleeding.

The limitation of push endoscopy is still its limited reach because the lesions in the distal small intestine, closer to the colon cannot be diagnosed.

The risks of push endoscopy are the same as in standard endoscopic procedures like bleeding and perforation of the intestine, which is increased because of the use of an overtube.

Standard endoscopy is a procedure to examine the esophagus (swallowing tube), stomach, and duodenum (first portion of small bowel) using a thin, flexible, 120 cm long tube with a camera on their tips.

It is usually performed to evaluate possible problems with the esophagus, stomach or duodenum, and evaluates symptoms such as upper abdominal pain, nausea or vomiting, difficulty in swallowing, intestinal bleeding anemia, etc.

Sometimes a colonoscopy, similar to the upper gastrointestinal endoscope but 180 cm in length, can be used to reach a little further into the small intestine, but the additional reach of colonoscopy is limited.

The problem is not in the length of the endoscope, rather than in the path of the endoscope through the stomach and duodenum because it is twisty and the endoscopes curl in the stomach, and the small intestine is not fixed in place so this makes the advancement of the endoscopes even more difficult.