**3. Techniques**

*Endoscopy in Small Bowel Diseases*

**96**

**Figure 5.**

**Figure 6.**

if required in the same sitting.

• Failure of DAE to identify or treat the lesion – Often, complete small bowel examination is not possible with DAE. The reasons for failure of DAE include previous laparotomies, bowel adhesions, anatomical variations, etc. [21]. In such cases, IOE is useful in achieving complete bowel evaluation and treatment

*Intraoperative enteroscopy via enterotomy of a patient with resolving acute pancreatitis and colonic obstruction showing mucosal edema at the site of obstruction (A, B) with grossly dilated colon loaded with feculent material (C).*

*Intraoperative enteroscopy via enterotomy of a patient with multiple small bowel strictures on computed tomography showing a narrow stricture in the proximal ileum (A). Rest of the small bowel showed mild* 

*mucosal edema at few places with no obvious strictures (B, C, D).*

• Abdominal surgery required for other reasons – In some situations such as CD with symptomatic gallstone disease or FAP with periampullary carcinoma, if

IOE is mainly performed via conventional laparotomy. However, it can be performed by mini-laparotomy [22, 23] or laparoscopy [24–27]. IOE can be performed by gastroscope, colonoscope, pediatric scope or balloon enteroscope depending upon the probable site of the lesions, the indication for IOE and the availability of the equipments. In rare circumstances, IOE can be performed using a laparoscope [28]. IOE can be conducted through oral route, anal route and through an enterotomy site (**Figure 7**). The choice of the preferred route for IOE depends upon the location of the lesion.

The patients are admitted before the procedure. All routine investigations including cardiorespiratory work up are done to rule out any contraindication for surgery. The day before the procedure the standard bowel preparation (the same as for colonoscopy) with either polyethylene glycol or sodium phosphate is given [29]. The patients are asked to fast for 6 hours before the surgery.

All the endoscopes and the accessories are sterilized before the procedure. The endoscopist has to scrub like any other member of the operating team. The part of the endoscope to be inserted in the operating field is covered with a plastic sleeve routinely used for laparoscopic procedures. This will help in maintaining the sterility of the procedure. The procedure is performed under general anesthesia.
