K Klímová1, J Trna, J Tomásek. 1. Interní hepatogastroenterologická klinika FN Brno a LF Masarykovy univerzity, Brno. kliminka@hotmail.com
Abstract
BACKGROUNDS: Familial polypous syndromes include, in particular, familial adenomatous polyposis, Peutz-Jeghers syndrome and familial juvenile polyposis. The cumulative risk of developing cancer of the small intestine is higher and ranges between 5 to 13%. Close follow-up is therefore very important in the prevention of both malignant and benign complications of the basic disease. Currently there are many methods that can be offered to follow up patients with hereditary polyposis syndromes.The anatomy of the gastrointestinal tract can be investigated by endoscopy or double-contrast radiological techniques. The part of the small intestine between the duodenum and terminal ileum is difficult to reach by standard endoscopy and can only be judged by radiological enteroclysis, which has the disadvantage of exposing the patient to X-rays, moreover, it is impossible to examine the pathological findings histologically. However, new and more accurate enteroscopical (single and double-balloon, including intraoperative) methods and capsule enteroscopy have recently started to be used in routine clinical practice: Capsule endoscopy is an endoscopical method that enables us to examine the whole small intestine.This technology consists of swallowing a capsule the size of a bean that is later moved by motility of the gastrointestinal tract distally. A doctor then evaluates the record. Intraoperative enteroscopy is ever more often substituted by balloon enteroscopy. However, it remains a possibility when traditional double-balloon enteroscopy does not solve the patient's problems definitely; this occurs mainly in patients with intestinal adhesions or multiple lesions of the small intestine, endoscopically insolvable. Balloon enteroscopy is a modern endoscopic method that is used to examine the whole small intestine that also enables therapeutic efforts to be carried out when routine endoscopy is not successful. In some indications it has substituted intraoperative enteroscopy. CONCLUSION: These three methods are complementary, are connected in the examination algorithm and cannot be replaced by each other. Some authors consider them the golden standard in investigating the small intestine.
BACKGROUNDS: Familial polypous syndromes include, in particular, familial adenomatous polyposis, Peutz-Jeghers syndrome and familial juvenile polyposis. The cumulative risk of developing cancer of the small intestine is higher and ranges between 5 to 13%. Close follow-up is therefore very important in the prevention of both malignant and benign complications of the basic disease. Currently there are many methods that can be offered to follow up patients with hereditary polyposis syndromes.The anatomy of the gastrointestinal tract can be investigated by endoscopy or double-contrast radiological techniques. The part of the small intestine between the duodenum and terminal ileum is difficult to reach by standard endoscopy and can only be judged by radiological enteroclysis, which has the disadvantage of exposing the patient to X-rays, moreover, it is impossible to examine the pathological findings histologically. However, new and more accurate enteroscopical (single and double-balloon, including intraoperative) methods and capsule enteroscopy have recently started to be used in routine clinical practice: Capsule endoscopy is an endoscopical method that enables us to examine the whole small intestine.This technology consists of swallowing a capsule the size of a bean that is later moved by motility of the gastrointestinal tract distally. A doctor then evaluates the record. Intraoperative enteroscopy is ever more often substituted by balloon enteroscopy. However, it remains a possibility when traditional double-balloon enteroscopy does not solve the patient's problems definitely; this occurs mainly in patients with intestinal adhesions or multiple lesions of the small intestine, endoscopically insolvable. Balloon enteroscopy is a modern endoscopic method that is used to examine the whole small intestine that also enables therapeutic efforts to be carried out when routine endoscopy is not successful. In some indications it has substituted intraoperative enteroscopy. CONCLUSION: These three methods are complementary, are connected in the examination algorithm and cannot be replaced by each other. Some authors consider them the golden standard in investigating the small intestine.