Article is provided by the medical centre "Clinic 31".
Why the small intestine always was «novel area» gastroenteric path and what has changed in the new millennium? How it is possible to examine the longest human organ from within, without resorting to operative intervention? What introduce in clinical diagnostics and treatment of diseases of a small intestine modern endoskopichesky methods?
Topical issues of an enteroskopiya.
For many years the small intestine remained the most remote and low-studied body of the gastroenteric highway. Difficulties of endoskopichesky diagnostics of diseases of a small intestine, first of all, have been caused by considerable extent of body, existence of numerous bends and mobile loops, and also technical imperfection of existing optical devices. Ideas of macroscopical details of changes of a small intestine have always been limited because of difficulties of their lifetime diagnostics. More often clinical physicians were content with results of survey of proksimalny sites of a lean gut at carrying out a gastroduodenoskopiya, and survey of terminal department of a podvzdoshny gut, at carrying out a kolonoskopiya.
However, throughout all history of a modern gibkovolokonny endoskopiya, that is for the last fifty years, numerous attempts of research of all small intestine with use of optical devices were undertaken. A part of the developed methods, such as the zondovy enteroskopiya and an enteroskopiya on the conductor, have not found wide application. Devices became museum pieces, having served as a prototype technologically more perfect techniques, for example - a video capsular endoskopiya. Other methods, such as the active forward enteroskopiya laparoskopicheski-assisted and an intraoperatsionny enteroskopiya and are to this day in an arsenal of doctors, but their application is limited or insignificant depth of penetration, or strict and rather rare indications.
Medical endoskopichesky interventions in deep departments of a lean and podvzdoshny gut were carried out seldom and generally only during an intraoperatsionny intestinoskopiya that took place in emergency surgery more often.
Replenishment of an arsenal of the beam methods of research of a small intestine checked by time, such as a zondovy enterografiya, an angiografiya, a radio isotope stsintigrafiya, modern means of indirect visualisation (a magnetic and resonant enterografiya, a computer tomography with a kontrastirovaniye), certainly, has improved diagnostics of diseases of a small intestine. But even three-dimensional reconstruction of the image of a small intestine (a virtual enteroskopiya) is not capable to find the whole range of its not volume defeats.
Modern methods of endoskopichesky research of a small intestine - a video capsular enteroskopiya (fig. 1) and the ballonno-assisted enteroskopiya (fig. 2), today - the unique methods of the guaranteed high-quality survey of a small intestine with possibility of a capture of fragments of its mucous membrane for research under a microscope, and also, in some cases, - performance of the low-invasive medical interventions which are not demanding a big "surgical" cut.
Fig. 1 - Videokapsula of the Fig. 2 - System for an odnoballonny enteroskopiya
The main indications for performance of a video capsular endoskopiya and the ballonno-assisted enteroskopiya are:
- tonkokishechny bleedings (often being shown only zhelezodefitsitny anaemia and the positive analysis a calla on hidden кровопотерю);
- suspicion on existence of a tumour of a small intestine (stated at radiological methods of research or ultrasonography), в.т.ч. at syndromes intestines polypose;
- suspicion on an enteropatiya (in these cases, speech goes about a tseliakiya more often),
- diagnostics of defeat of a small intestine at an illness Krone.
The video capsular enteroskopiya can be carried out as in out-patient, and stationary conditions. The only thing that is required from the patient, is a desire to execute research, preparation of a small intestine for it by means of reception of special preparations clearing a gut in day on the eve of research, and a proglatyvaniye of the capsule. Then direct process of inspection which proceeds within 9-10 hours for which the capsule passes all gastroenteric path begins and does numerous pictures (on the average 56000-57000) on a course of "travel".
All received information via special sensors passes to perceiving device, from which the doctor (after the completion of research) transfers information in the computer, analyzes it and draws the conclusion by the received results. During research the patient can be engaged in affairs habitual and necessary for it. Soon, after a capsule proglatyvaniye, it can start to eat according to recommendations of the doctor. The fulfilled capsule leaves independently with a chair.
Certainly, the video capsular enteroskopiya is the idle time for the patient a method of research of all small intestine, but, at the same time, is the method having the greatest diagnostic value, and in diagnostics of sources of tonkokishechny bleedings (60-80 %), tumours (63-90 %), and an illness Krone (58-85 %).
Ballonno-assistirovannaya an enteroskopiya more serious procedure demanding, as a rule, carrying out anaesthesia and a sedatsiya and, sometimes, to hospitalisation in a hospital. Endoskopichesky intervention is carried out by means of special long энтероскопа and a "shiniruyushchy" tube with an inflated cylinder on the end that promotes deep carrying out the device. Carrying out an enteroskopiya allows to examine more carefully a gleam and a gut wall, and if necessary to take fragments of its mucous membrane for research under a microscope. In case of identification of a source of bleeding, good-quality new growths or any other pathology demanding medical influence, it can be executed via the tool channel энтероскопа, thereby saving the patient from a big surgery. Undoubtedly, the question of need and possibility of carrying out an enteroskopiya should be solved with the experts specialising on diagnostics of diseases of a small intestine.
The clinic 31 of one of the first in Russia has begun carrying out video capsular researches of a small intestine. Since 2003, her employees had possibility to study feature of application of all existing systems for a capsular endoskopiya, and have stopped the choice on the most high-quality equipment of the Olympus companies (Japan), «MiroCam» (Korea), Given Imaging (Israel). In February 2007г. the clinic became "pioneer" of introduction in clinical practice of our country and world endoskopichesky community of an odnoballonny enteroskopiya of the Olympus company (Japan), and with 2010г. to master a dvukhballonny enteroskopiya of the Fujifilm company (Japan), having carried out in total more than 230 researches. Daily practical work, and also participation in domestic and foreign conferences, allows to be improved in the professional knowledge and ability. Specialists of the centre have passed training on an enteroskopiya in leading clinics of Japan - Showa University Hospital, Yokohama (the instructor of Prof. Ohtsuka K.), Jichi Medical University, Tochigi-ken (instructor of Prof. Yamamoto H.); clinics of Europe - KommuneHospital Aarhus, Denmark (the instructor of Prof. Kruse A.), Universitatsklinikum Erlangen, Germany (instructor, Prof. Raithel M). Experience in the field of a capsular endoskopiya and the ballonno-assisted enteroskopiya of employees is reflected in reports in the domestic and foreign congresses, published articles, the methodical recommendations, training video films. The clinic 31 also imparts experience saved up with the doctors-trainees coming from other cities and the countries for training to bases of an enteroskopiya and receiving experience of performance of interventions.
Specialists of clinic, being based on the experience, can tell with confidence that diseases which were considered earlier as the extremely rare, come to light even more often, and that is important, - at earlier stage. In turn, it gives the chance to appoint to suffering patients reasonable medicamentous treatment, to carry out necessary intervention by malotravmatichny way - through энтероскоп, or to define indications for treatment through surgical access.
The main publications of clinic on a subject.
- Fedorov E.D., Ivanov E.V., Timofeev M. E., Yudin O. I. A diagnostic and medical endoskopiya of a small intestine with use odnoballonny энтероскопа. РЖГГК, 2008. Прилож. No. 32, Page 185
- Fedorov E.D., Ivanov E.V., Timofeev M. E., Chernyakevich P. L., Andreeva O. N. Diagnostic possibilities of an odnoballonny enteroskopiya. РЖГГК, 2010, No. 2, Tom XX, Page 44-53
- Fedorov E.D., Ivanov E.V., Timofeev M. E., Chernyakevich P. L., Yudin O. I., Kuznetsov D. A. Enteroskopiya in diagnostics of tumours of a lean and podvzdoshny gut Experimental and clinical gastroenterology. 2010, No. 10, Page 101-109
- Ivanov E.V., Fedorov E.D., Chernyakevich P. L., Timofeev M. E., with соавт. Modern videoendoskopichesky technologies in diagnostics and treatment of diseases of a small intestine. Kremlin medicine. 2011, No. 3, Page 117-124
- Ivanov E.V., Timofeev M. E., Chernyakevich P. L., Kadnikova U.A., Tsodikova O. M., Fedorov E.D. Endoskopichesky diagnostics of an illness Krone of a small intestine with application of a video capsular and ballonny enteroskopiya. Clinical endoskopiya. 2011, No. 2 (28), Page 2-13
- Fedorov E., Ivanova E., Timofeev M., Yudin O. The extent, limits and complications of diagnostic and therapeutic single-balloon enteroscopy in patients with small bowel abnormalities. Gut 2009, Vol.57, A233
- Fedorov E., Ivanova E., Yudin O., Timofeev M. Gastrointestinal Endoscopy. The benefits of balloon-assisted enteroscopy in pts with intestinal bleeding: from precise diagnosis to reasonable treatment. 2010, Vol.71, No. 5, AB374, W1619
- Ivanova E.V., Boodsinsky S.A., Orlov S.Y., Timofeev M.E., Fedorov E.D. Endoscopic interventions in biliary and pancreatic ducts through the single balloon enteroscope. Endoscopy, 2010, Suppl.1., A157
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Authors of article:
Ivanov Ekaterina Viktorovn, candidate of medical sciences, leading expert of the medical centre «Clinic 31». The senior research associate РНИМУ of Pirogov. Full member of the European society of a gastrointestinalny endoskopiya.
Fyodorov Evgeny Dmitriyevich, doctor of medical sciences, main adviser of the medical centre «Clinic 31». Main research associate; manager. an elektivny course of operative endoskopiya РНИМУ of N.I.Pirogov and FFM Moscow State University. Secretary general of the Russian Endoskopichesky Society. Full member of the American society of a gastrointestinalny endoskopiya.