Push endoscopy (also referred to as push enteroscopy) is a procedure that allows diagnosis and treatment of diseases in the upper small intestine. Push endoscopy reaches further into the small intestine than the standard upper gastrointestinal endoscopy (also known as esophagogastroduodenoscopy, EGD).
Endoscopes for push endoscopy are similar in length to colonoscopes, approximately 200cm and have working channels for diagnostic and therapeutic procedures. After the endoscope is passed into the duodenum, a more rigid overtube is passed over the endoscope to straighten its path. With the overtube in place, the endoscope then can be advanced without coiling in the stomach.
Push endoscopy is a useful procedure for examining and delivering therapy in the small intestine. For example, for patients with intermittently bleeding angiodysplasias (clusters of weakened blood vessels) located in the small intestine beyond the reach of a standard upper endoscope, push endoscopy can be helpful in both diagnosing the bleeding site as well as in stopping the bleeding.
Push endoscopy has its limitations. Its reach is still limited and cannot diagnose lesions in the distal small intestine (intestine closer to the colon). The major risks of push endoscopy are the same as other endoscopic procedures, bleeding and perforation of the intestine, either due to passage of the endoscope or the accompanying therapeutic procedures. Because of the use of an overtube, the risk of perforation probably is increased over the risks of an endoscope alone.