**1. Introduction**

226 Gastrointestinal Endoscopy

Winawer S., Zauber A., Ho M., O'Brien M., Gottlieb L., Sternberg S., Waye J., Schapiro M.,

19771981. ISSN 0028-4793.

Bond J., Panish J., Ackroyd F., Shike M., Kurtz R., Lewis L., Gerdes H., Stewart E., & the National Polyp Study Workgroup. (1993) Prevention of colorectal cancer by colonoscopic polypectomy. *New England Journal of Medicine,* Vol. 329, No. 27, pp.

> Numerous advances have recently been made in endoscopy for both diagnosis and treatment of gastrointestinal diseases. However, these advances have taken little account of the small bowel, as access by endoscopy is often difficult. With the advent of push endoscopy in 1971, the proximal jejunum could be examined to about 50 cm from the ligament of Treitz. The subsequent introduction of videoendoscopy combined with an overtube enabled us to examine the whole jejunum. The most recent discoveries—capsule endoscopy and double-balloon enteroscopy—have improved our ability to examine the small intestine. Capsule endoscopy has provided us with a new challenge, namely, how to diagnose and treat the lesions found. Hospitals with a small bowel unit in which doubleballoon enteroscopy and push endoscopy are available can provide an effective solution in a large percentage of cases. In hospitals where these techniques are not available, lesions identified in the jejunum must be resolved using non-balloon enteroscopy. Colonoscopy is a well-known alternative, although its rigidity and caliber prevent it from advancing smoothly through the jejunum. An intermediate solution could be found in the pediatric colonoscope, which is smaller in cross-section and more flexible and has a working channel that enables therapy to be administered.

> In this chapter, we describe the different diagnostic therapeutic approaches to lesions of the small bowel. We also examine the application of endoscopy, including the possibilities offered by the pediatric colonoscope in the diagnosis and treatment of lesions found using capsule endoscopy.
