What Is Push Enteroscopy?

A push enteroscopy (also known as a push endoscopy) is a diagnostic procedure ordered by a gastroenterologist, typically after a battery of other tests have been performed. Upper endoscopy is a procedure performed by inserting a thin tube with a small camera attached into the mouth and down through the throat in order to examine the upper portion of your gastrointestinal tract, down to the first two parts of the duodenum. It can find and diagnose diseases such as gastric cancer, ulcers, esophageal conditions, and more. However, sometimes your healthcare provider may find something and need more information. A push enteroscopy is an endoscopy that is “pushed” a little further down the GI tract, thus its name. A push enteroscopy allows your physician to see the entire duodenum and the first part of the jejunum, which are parts of the small intestine. This closer look allows your healthcare provider to diagnose different gastrointestinal conditions based on their findings.

What Is Upper Endoscopy?

An upper endoscopy is used to diagnose gastrointestinal disturbances in the upper part of the GI tract. It is synonymous with the acronym, EGD which stands for Esophago-

Gastro-Duodenoscopy. In some cases, an upper endoscopy can also treat conditions. It can widen the esophagus, stop some internal bleeding, and can remove polyps in the upper portion of the digestive tract.

Mainly, however, upper endoscopy is ordered when a patient presents with symptoms, and the gastroenterologist needs more information in order to provide the patient with a diagnosis.

During an upper endoscopy, a long, thin, and flexible tube is inserted into the mouth. The tube has a small camera attached to it that allows the gastroenterologist to see the mouth, throat, esophagus, stomach, and the duodenum, which is the uppermost part of the small intestine. Symptoms that may prompt your doctor to order an endoscopy include:

• Unexplained weight loss
• Abdominal pain or cramping
• Nausea and vomiting 
• Trouble with swallowing
• Acid reflux (heartburn)
• Bleeding 

These are signs that indicate something may be wrong with the upper portion of your gastrointestinal tract.

Some of the diseases and conditions that an endoscopy can diagnose include:

• Gastroesophageal reflux disease (GERD)
• Gastric cancer
• Narrowing of the esophagus
• Barrett’s esophagus
• Esophageal cancer
• Ulcers
• Celiac disease
• Gastritis 

However, the limitation of the upper endoscope is that it can only reach the duodenum, the upper part of the small intestine. Your physician may want to examine more of your small intestine to diagnose or rule out any problems.

What Is a Push Enteroscopy vs. an Endoscopy?

A push enteroscopy is like an upper endoscopy; it just has added equipment to push the endoscope further into the small intestine without the tube coiling up in the stomach. The endoscope used for a push enteroscopy is similar in length to that of a colonoscopy (roughly 79 inches/200 cm). The beginning of a push enteroscopy is similar to that of an upper endoscopy—the physician will insert the endoscope into the mouth and down through the stomach to the duodenum. From there, it is advanced as far as safely possible into the jejunum. While endoscopy can view the top portion of the duodenum, a push enteroscopy can view the entire duodenum as well as the jejunum, another part of the small intestine. A physician will order a push enteroscopy typically after other tests have been inconclusive but are indicative of a problem. The gastroenterologist may see tumors, bleeding in the GI tract, bowel obstruction, or an increased white blood cell count.

How Do I Prepare for a Push Enteroscopy?

Some preparation is needed before a push enteroscopy, and your doctor should provide you with specific instructions on what to do. Typically, your doctor will advise you not to take certain medications, like blood thinners or aspirin, and to stop eating solid foods at least 12 hours before the test. You may be allowed to have clear liquids in the morning. The doctor will administer anesthesia through an IV, and then the test will begin. After the test, you must stay in the recovery room for several hours, but push enteroscopy is an outpatient procedure, and you will go home the same day.

Are There Any Risks with Push Enteroscopy?

There is always a small amount of risk when it comes to any type of surgical procedure, but enteroscopy is a safe, painless procedure that usually does not cause side effects. You may have some stomach bloating immediately after the procedure, but this should go away by the time you leave the recovery room. Other complications post-push enteroscopy include a sore throat, abdominal cramps, and nausea. If your physician took tissue samples (biopsy) during the procedure, you might have a small amount of bleeding afterward, but this is completely normal. Serious complications, such as gastric or intestinal perforation, are very rare and occur less than 1% of the time.