The role of enteroscopy in the diagnosis and interventional management of small intestine diseases

Evaluation of the small intestine is technically difficult because of its length and anatomy. Capsule endoscopy and device-assisted enteroscopy (DAE) have expanded diagnostic and therapeutic options in recent years. This narrative review summarizes the current indications, therapeutic procedures, safety, and role of enteroscopy compared with other small bowel imaging methods. A literature search was performed in the MEDLINE database covering publications from February 2001 to February 2025, using predefined inclusion and exclusion criteria. The main indications include small intestinal bleeding, inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease, celiac disease, and tumors of the small intestine. Enteroscopy allows identification of bleeding sources, assessment of disease extent and complications, and detection of neoplastic lesions. Capsule endoscopy is usually the first test performed because it is less invasive. However, DAE allows tissue sampling and therapeutic intervention if abnormalities are detected. It can also be useful in cases where non-invasive imaging is inconclusive. The main therapeutic procedures include hemostasis, balloon dilation of short symptomatic strictures, polypectomy, and foreign body removal. Balloon dilation is recommended for selected benign strictures and may reduce the need for surgery. Enteroscopy is considered a safe procedure. The overall risk of complications ranges from 0.4% to 5.5% for both double-balloon and single-balloon enteroscopy, with no significant difference between them. Major adverse events, including perforation, pancreatitis, and bleeding, are uncommon and generally do not exceed 3%. The risk is higher in therapeutic interventions. Elderly patients are more likely to experience sedation-related side effects, including aspiration and hypoxia. Despite its advantages, enteroscopy remains technically demanding and mostly available in specialized centers. Further standardization and wider availability are needed.