Dr. Rohit V. Patil, MD

Enteroscopies may be used alone or in combination with other procedures. For example, if a doctor suspects malignancy (cancer) in the small bowel, she may use an enteroscope to take a sample of tissue from the small bowel and have it examined in a laboratory. If there is a blockage in the small intestine that cannot be surgically removed, an enteroscopy-guided stent placement may help relieve some of the symptoms associated with the obstruction. Enteroscopes may also be used to treat intestinal bleeding and remove abnormal growths like tumors and polyps, as well as foreign objects that might have found their way into the small bowel.

There are several ways to perform an enteroscopy:

• Push enteroscopy involves the use of a long tube with a camera, called an enteroscope. Depending on the location of the problem, the enteroscope is either passed through the mouth or rectum. This technique is often used to detect and stop bleeding in the upper small intestine.
• Balloon enteroscopy uses scopes that have tiny balloons at the tip. The balloons inflate and deflate to help make the passage of the scope into the small bowel easier. This method is used when there is a need to access and treat certain parts of the small intestine that push enteroscopy cannot reach.
• Capsule enteroscopy involves swallowing a capsule with a tiny camera inside it. As the capsule travels through the small intestine, the camera records and sends images that are then downloaded and analyzed by the doctor. The capsule eventually leaves the body during bowel movement. If the doctor needs to visualize the entire small intestine, capsule enteroscopy is the only option. The only drawback to this technique is that it cannot be combined with any treatment.

Enteroscopy is typically performed at the doctor's office and takes about 20 to 30 minutes, but may take longer if combined with another procedure. Patients may have a sore throat for a few hours if the scope was inserted through the mouth. Normal activities may be resumed about 24 hours following enteroscopy.

Kidney stones can be smooth or jagged and are yellow to brown in color. They are mostly comprised of the minerals calcium, oxalate, and phosphorus. Examining the stones to see what they are made of can show what caused the stone to be formed in the first place. For example, a stone made of mostly calcium, which is the most common type, can happen any time the urine becomes too concentrated due to dehydration or a blockage in the kidney. A uric acid stone forms when acid levels in the urine get too high, usually due to excessive consumption of animal protein such as meat and fish. A struvite stone is a sign of certain infections, and a cystine stone can be due to a genetic disorder that raises the risk of kidney stones.

The most common symptom of kidney stones is pain, either in the back or lower abdomen, or severe pain when urinating. There may also be blood in the urine. Treatment for kidney stones depends on how large the stone is. Very small stones can pass out of the body on their own, and they do not require treatment other than drinking adequate water and taking pain killers. Larger stones need to be broken apart and removed. The main treatment options are:

• Shock wave lithotripsy, which uses sound wave vibrations to break apart the stone
• Percutaneous nephrolithotomy, or the use of a very tiny tool (like a wire inserted through the back) to break apart and remove the stone
• Ureteroscopy, a thin tube inserted through the urethra and bladder to the stone, where tiny tools can grasp the stone and remove

People who have had one kidney stone are at risk of developing another. To reduce this risk, patients are given instructions specific to the type of stone they developed. Generally the instructions will include drinking more water to dilute the urine, but it may also involve lowering sodium intake or eating less meat.

During the procedure, the surgeon inserts the laparoscope, which contains a light and camera that allows the surgeon to see what is happening inside the body. Then tiny tools are placed through the small openings and used to perform the surgery.

The most common laparoscopic surgery is gallbladder removal, but laparoscopic surgery may also be used for the removal of a kidney or appendix, to treat certain cysts and tumors, for bariatric surgery, for some GERD treatments, or for hernia repairs, among others.

Because laparoscopic surgery only uses a few tiny incisions, the scars are minimal and recovery is easier than with open surgery.