Evaluation of the small bowel is difficult due to its length, intraperitoneal location, and contractility. Methods used to evaluate the small bowel include push enteroscopy, video capsule endoscopy, and intraoperative enteroscopy. These techniques all have advantages and limitations:
●Push enteroscopy has both diagnostic and therapeutic capabilities, but typically only examines that part of the small bowel that is 50 to 150 cm distal to the ligament of Treitz
●Video capsule endoscopy is capable of examining the entire small bowel, but lacks therapeutic capacity
●Intraoperative enteroscopy permits examination of the entire small bowel and therapeutic interventions, but is much more invasive
Alternative endoscopic approaches have been developed to overcome these limitations. Deep small bowel enteroscopy permits visualization and interventional therapy throughout the small bowel by using insertion techniques that pleat the small bowel onto an overtube. The techniques used for deep small bowel enteroscopy limit stretching of the small bowel (as occurs with push enteroscopy), permit better transmission of maneuvers designed to position the tip of the enteroscope, and stabilize the enteroscope, thereby facilitating therapeutic interventions.