**6. Summary**

234 Gastrointestinal Endoscopy

using single-balloon or double-balloon enteroscopy or spiral enteroscopy. These new endoscopes are flexible and generally have a 2.8-mm working channel that partially collapses after passing through several loops, thus making it difficult to insert commercially available catheters. In addition, they are not universally available. An alternative in the case of proximal lesions of the small bowel (mainly the jejunum) is to use a pediatric colonoscope with a 3.2-mm channel, which makes it easy to insert even metal prostheses or the catheters habitually used in colonoscopy. The caliber of the standard working channel is 2.8 mm (2.2 mm in the diagnostic double-balloon enteroscope). Another advantage of this type of colonoscope is that it is more flexible and manageable than a standard colonoscope,

Therefore, a pediatric colonoscope with a 3.2-mm working channel can be used as a push enteroscope to treat jejunal lesions. We can use any type of catheter applied in colonoscopy (this does not need to be longer, as is the case with standard push enteroscopy) and we can insert sclerotherapy needles to mark the lesions identified and the furthest point reached. Hemoclips can also be used for this purpose. If necessary, ink marks can be visualized using capsule endoscopy, and clips are easily identified on a plain radiograph (Figure 5) or can be

Fig. 5. Note the 2 hemoclips (arrow) marking the distance reached with the pediatric

Indian ink) in order to locate lesions or the most distal point reached.

Our experience shows that diagnosis is not always consistent: capsule endoscopy did not reveal the lesions we expected to find in the section examined or there were no identifiable lesions. Push endoscopy using a pediatric colonoscope, on the other hand, made it possible to identify the lesions to be treated (argon plasma, hydropneumatic dilation), take biopsy specimens to provide an accurate diagnosis (stenosis caused by Crohn disease, jejunal carcinoma in patients with celiac disease), and, importantly, mark the bowel (hemoclips or

enabling us to reach more distal parts of the jejunum.

palpated by the surgeon.

colonoscope

Capsule endoscopy is the technique of choice for examination of the small bowel. Several options are available for treatment, including balloon-assisted enteroscopy or spiral enteroscopy. A pediatric colonoscope enables us to perform the examination using conventional push enteroscopy (50 cm from the angle of Treitz), take biopsy specimens, administer endoscopic treatment of the lesions found, and mark lesions using standard clinical techniques. It has the advantages that it can be performed in selected patients at any hospital without the need for advanced technology and enables metallic prostheses to be inserted.
