Small Intestine: Exploring the Last Great Frontier for Gastrointestinal Endoscopy

Charles J. Lightdale, MD, Consulting Editor

The small intestine—with its daunting length and sharp turns—was an impossible barrier to cross in early gastrointestinal endoscopy. The emerging technologies of video capsule endoscopy and deep enteroscopy have now provided the cameras and guns for increasing numbers of inveterate gastrointestinal endoscopists to explore the entire dimensions of this last frontier. It’s still a wild space to map, but the need to do so is evident. Bleeding from the small intestine is on the rise probably related to many factors, including longer life spans, associated heart and kidney disease, nonsteroidal anti-inflammatory drugs, and anticoagulation. Inflammatory bowel disease and celiac disease are on an uptick, and while small bowel neoplasia is uncommon, diagnosis can pose a major problem. Important new radiologic tools are also now available to bolster endoscopic exploration, including computer tomographic enteroscopy and angiography and magnetic resonance enterography.

This issue of Gastrointestinal Endoscopy Clinics of North America on the “Evaluation of the Small Intestine” is a remarkable and comprehensive presentation of the state-of-the-art. Dr Lauren Gerson, the editor for this issue and a renowned leader in gastroenterology, has selected topics that truly cover the field and are written by an outstanding group of authors. The issue begins with a terrific review of the anatomy and physiology of the small bowel, essential information for any endoscopic explorer. Reviews follow on video capsule technique and interpretation, double-balloon enteroscopy, and single-balloon enteroscopy. The key diseases of the small bowel are covered in great detail: angiodysplasia, inflammatory disorders, celiac disease, and neoplastic diseases. The roles of radiologic techniques and intraoperative enteroscopy are thoroughly presented as well. Finally, in a superb coda, there is an updated, invaluable algorithm and outcomes discussion for small bowel bleeding.

Gastroenterologists, surgeons, radiologists, listen up—the small intestine frontier is open and teamwork is mandatory. It all becomes clear in this issue of the Gastrointestinal Endoscopy Clinics of North America .

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