Enteroscopy and Capsule Endoscopy

Endoscopy of the small bowel has always been problematic due to the technical problems associated with long endoscopes. Standard "push" endoscopes rarely advance beyond the mid-jejunum. "Sonde" enteroscopes are designed to view the entire small bowel; a very long, thin endoscope with a balloon on the tip advances down the small bowel by peristalsis, aided by patient positioning and a prokinetic agent (eg, metoclopramide). Unfortunately, the Sonde procedure is time consuming (typically 6 to 8 hours), uncomfortable for the patient (cramps) and has a yield of only 30% for pathology, even in the best hands. Recently, remote sensing endoscopy—so-called "capsule endoscopy"—has provided an easier and more sensitive way to look at the small bowel. Data on capsule endoscopy in the setting of recurrent severe lower GI bleeding are limited, but this technique has "picked up" previously unsuspected pathology, such as small bowel varices. Although mainly used to look for causes of chronic occult GI blood loss, capsule endoscopy may have a role in examining patients who present with repeated hematochezia without a likely colonic source. This is discussed in the chapter on occult bleeding (see Chapter 59).

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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