title: Diagnostic yield of routine push enteroscopy with a graded-stiffness enteroscope without overtube.
abstract: BACKGROUND
  Push enteroscopy has become a standard procedure for evaluation of small intestinal disorders. Its diagnostic yield and acceptability, however, has been hampered by the use of an overtube, which is both inconvenient and potentially hazardous. This study assessed the clinical value of enteroscopy with a graded-stiffness videoenteroscope without an overtube.
  
  
  METHODS
  A total of 121 consecutive patients (mean age 59 years, range 12-89 years) underwent diagnostic enteroscopy. All procedures (n = 126) were performed with a push-type graded-stiffness videoenteroscope without an overtube. Indications were the following: unexplained iron deficiency anemia (45%), GI bleeding (29%), abdominal pain (6%), malabsorption (5.5%), imaging abnormality (5.5%), diarrhea (4%), intestinal obstruction (3%), and vomiting (2%).
  
  
  RESULTS
  The mean depth of instrument insertion distal to the pylorus was 121 cm. A diagnosis was made in 40% of all procedures. The findings included ulcerations or erosions in 43%, angioectasia in 35%, inflammation in 14%, tumors in 6%, and varices in 2%. In all cases of a positive enteroscopic diagnosis, therapeutic maneuvers were performed, and no patient needed a further diagnostic procedure. Patient comfort was good. No complications were observed.
  
  
  CONCLUSIONS
  Routine enteroscopy with a graded-stiffness enteroscope without an overtube is safe and comfortable for the patient and the endoscopist, and has a clinical efficacy comparable with that reported for enteroscopy with use of an overtube. A prospective, randomized study is warranted to assess the exact role of this form of enteroscopy in patient care.
authors.affiliation: Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Israel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Keizman
authors.forename: Shlomo
authors.initials: S
authors.lastname: Brill
authors.forename: Mark
authors.initials: M
authors.lastname: Umansky
authors.forename: Yacob
authors.initials: Y
authors.lastname: Rattan
authors.forename: Aharon
authors.initials: A
authors.lastname: Hallak
authors.forename: Zamir
authors.initials: Z
authors.lastname: Halpern
authors.forename: Fred M
authors.initials: FM
authors.lastname: Konikoff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies