Small-bowel capsule endoscopy (SBCE)
 1 ESGE recommends that prior to SBCE patients ingest a purgative (2 L of polyethylene glycol [PEG]) for better visualization. Strong recommendation, high quality evidence. However, the optimal timing for taking purgatives is yet to be established. 2 ESGE recommends that SBCE should be performed as an outpatient procedure if possible, since completion rates are higher in outpatients than in inpatients. Strong recommendation, moderate quality evidence. 3 ESGE recommends that patients with pacemakers can safely undergo SBCE without special precautions. Strong recommendation, low quality evidence. 4 ESGE suggests that SBCE can also be safely performed in patients with implantable cardioverter defibrillators and left ventricular assist devices. Weak recommendation, low quality evidence. 5 ESGE recommends the acceptance of qualified nurses and trained technicians as prereaders of capsule endoscopy studies as their competency in identifying pathology is similar to that of medically qualified readers. The responsibility of establishing a diagnosis must however remain with the attending physician. Strong recommendation, moderate quality evidence. 6 ESGE recommends observation in cases of asymptomatic capsule retention. Strong recommendation, moderate quality evidence. In cases where capsule retrieval is indicated, ESGE recommends the use of device-assisted enteroscopy as the method of choice. Strong recommendation, moderate quality evidence. Device-assisted enteroscopy (DAE)
 1 ESGE recommends performing diagnostic DAE as a day-case procedure in patients without significant underlying co-morbidities; in patients with co-morbidities and/or those undergoing a therapeutic procedure, an inpatient stay is recommended. Strong recommendation, low quality evidence The choice between different settings also depends on sedation protocols. Strong recommendation, low quality evidence. 2 ESGE suggests that conscious sedation, deep sedation, and general anesthesia are all acceptable alternatives: the choice between them should be governed by procedure complexity, clinical factors, and local organizational protocols. Weak recommendation, low quality evidence. 3 ESGE recommends that the findings of previous diagnostic investigations should guide the choice of insertion route. Strong recommendation, moderate quality evidence. If the location of the small-bowel lesion is unknown or uncertain, ESGE recommends that the antegrade route should be generally preferred. Strong recommendation, low quality evidence. In the setting of massive overt bleeding, ESGE recommends an initial antegrade approach. Strong recommendation, low quality evidence. 4 ESGE recommends that, for balloon-assisted enteroscopy (i. e., single-balloon enteroscopy [SBE] and double-balloon enteroscopy [DBE]), small-bowel insertion depth should be estimated by counting net advancement of the enteroscope during the insertion phase, with confirmation of this estimate during withdrawal. Strong recommendation, low quality evidence. ESGE recommends that, for spiral enteroscopy, insertion depth should be estimated during withdrawal. Strong recommendation, moderate quality evidence. Since the calculated insertion depth is only a rough estimate, ESGE recommends placing a tattoo to mark the identified lesion and/or the deepest point of insertion. Strong recommendation, low quality evidence. 5 ESGE recommends that all endoscopic therapeutic procedures can be undertaken at the time of DAE. Strong recommendation, moderate quality evidence. Moreover, when therapeutic interventions are performed, additional specific safety measures are needed to prevent complications. Strong recommendation, high quality evidence.

/pdf/small-bowel-capsule-endoscopy-and-device-assisted-4dltzyt3z1.pdf

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

Complications of colonoscopy.

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

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.

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 …

Guidelines on small bowel enteroscopy and capsule endoscopy in adults

Complications of Colonoscopy

Purpose: To assess retrospectively the incidence, clinical features, and treatment of colonic perforation at computed tomographic (CT) colonography in a large multicenter cohort. Materials and Methods: The study was performed in accordance with the institutional ethics committees' requirements of a retrospective review in each of the participating centers, and no informed consent was required. A review of all patients who underwent CT colonography between January 2001 and December 2004 in 11 medical centers representing more than 95% of studies performed in a single country was performed to determine the rate of colorectal perforation. Data about patient demographics and patient- and procedure-related risk were recorded. Information about the location of the perforation, its likely mechanism, and treatment was collected. Analysis included calculation of rates of colonic perforation and surgical treatment and of 95% confidence intervals. Results: A total of 11 870 CT colonographic studies were performed in...

Colonic perforation at CT colonography: assessment of risk in a multicenter large cohort.

https://www.giejournal.org/article/S0016-5107(08)01356-4/pdf

Clinical Experience with a Nitinol Self-Expanding Colonic Stent - Data from the WallFlex-eR Colonic International Registry

Minimizing postcolonoscopy abdominal pain by using CO2 insufflation: A prospective, randomized, double blind, controlled trial evaluating a new commercially available CO2 delivery system

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Clinical Experience with a Nitinol Self-Expanding Colonic Stent - Data from the WallFlex-eR Colonic International Registry

Minimizing postcolonoscopy abdominal pain by using CO2 insufflation: A prospective, randomized, double blind, controlled trial evaluating a new commercially available CO2 delivery system