**3.2 IOE via anal route**

*Endoscopy in Small Bowel Diseases*

initiating IOE.

*route and (C) enteroscopy via enterotomy.*

**Figure 7.**

surgeon.

team.

transillumination.

avoid excessive tension on the mesentery.

• Deeper passage of the scope in to the jejunum is performed with the help of the operating team. Mobile small bowel and mesentery is necessary to facilitate smooth passage of the scope and avoid bowel injury. Hence, if adhesions are present then adhesiolysis should be performed by the operative team before

*Schematic presentation of different routes for intraoperative enteroscopy: (A) Transoral route, (B) transanal* 

• For the examination of the small bowel beyond the proximal jejunum, the operating surgeon straightens the bowel loops as the endoscopist gently pushes the endoscope in to the jejunum. Subsequently, about 40–50 cm of small bowel is telescoped on to the shaft of the endoscope by the operating

• Advancement of the endoscope through the small bowel must be smooth, slow, gentle and under direct vision to avoid mucosal trauma by the endoscope and

• The mucosa is thoroughly examined during the insertion and withdrawal of the endoscope. Any lesion if detected is biopsied or excised endoscopically using the standard techniques. Bleeding from the endoscopic excision site can be controlled by endoscopic techniques or transmural sutures by the operating

• If the lesion is big and requires surgical excision, then the site of the lesion

• In most cases, it is possible to examine the whole small bowel via oral route using the standard-length colonoscope. But if not possible, then the terminal

ileum can be examined in a retrograde fashion via transanal route.

• The distal most point up to which the scope reaches in the small bowel is

• Throughout the procedure, the operating room lights are dimmed so that the endoscopy team is able to clearly visualize the bowel mucosa and the location of the endoscope. The abnormal vascular lesions can be better identified by

• During withdrawal, after inspecting the mucosa, the air is aspirated by the endoscopist and the surgeon occludes the intestinal lumen with his index and

must be marked with a simple suture by the operating team.

marked with a simple suture by the surgical team.

middle fingers to avoid re-insufflation.

**98**

