الفهرس 
Endoscopy versus Radiology in diagnosis of small bowel diseasesOnly 14 pages are availabe for public view
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Abstract
A few years ago, the assessment of small bowel pathology was a major dilemma, especially when it came to the management of obscure gastrointestinal bleeding. Evaluation of the patients was frequently unsatisfactory because of the inability to completely visualize the small bowel mucosa with the available endoscopic and radiological techniques.
It is the most difficult part of the bowel to examine owing to the distance from the mouth to anus. Conventional endoscopic techniques for examining the small bowel are limited by its length and its multiple, complex, looped configurations.
The small bowel has ever since been the ”black box” of endoscopy In routine practice, only the last few centimeters of the ileum were accessible to retrograde visualization by ileocolonoscopy. Exploration from the proximal side by push, sonde or intraoperative enteroscopy was invasive procedures that did not always allow us to visualize the lesions in the small bowel.
New technology of wireless capsule endoscopy allows the endoscopic imaging of the complete small bowel. Capsule endoscopy has developed from being an emerging method in gastroenterology to become a clinical reality, and it must now be considered critically. It is a novel technology that facilitates highly effective and non-invasive imaging of the small bowel. It is a simple, safe, non-invasive, reliable technique, well accepted and tolerated by the patients, which allows complete exploration of the small intestine.Double balloon enteroscopy (DBE) is a new technique, first published and introduced into clinical practice in 2001 by Yamamoto, the inventor of this outstanding method. DBE allows complete visualization, biopsy and treatment of the small bowel.
Several years ago, the only methods to assess the small bowel were conventional enteroclysis or a small-bowel follow-through. In recent years, with the introduction of helical scanning and then Multidetector CT technologies, the accuracy for diagnosing digestive tract diseases with CT has been highly improved, and CT is used more and more in the evaluation of patients with suspected gastrointestinal disorders. Within this context, CT enterography, which is also referred to as ”CT enteroclysis,” was developed to enable the evaluation of luminal, extraluminal, and mural alterations of the small bowel.
CT Enterography is a new diagnostic tool in evaluating small bowel disorders and becoming the first-line modality for the evaluation of suspected inflammatory bowel disease. CT enterography has also become an important alternative to traditional fluoroscopy in the assessment of other small bowel disorders such as celiac sprue and small bowel neoplasms.
Also magnetic resonance imaging (MRI) is increasingly used in the assessment of small bowel diseases. Unlike conventional radiology, MRI enables visualization of disease extension beyond the intestinal wall, i.e., abscesses and fistulas.
Small bowel imaging has been revolutionized by CT enterography and capsule endoscopy. Both methods complement each other often providing information that the other one cannot.Capsule endoscopy and CT enterography may depict nonobstructive Crohn disease of the small bowel when conventional techniques such as ileoscopy or small-bowel follow-through produce negative or inconclusive findings.
Capsule endoscopy has been compared with traditional radiographic methods of examining the small bowel. Although this innovative diagnostic method has now entered clinical practice, it must be stressed that both push enteroscopy and intraoperative enteroscopy still have a precise and valid role in the management of patients with small-bowel diseases.