Advanced endoscopy · Patient guide
Enteroscopy, deep small-bowel endoscopy — push, double-balloon, single-balloon and spiral techniques.
Enteroscopy reaches deeper into the small bowel than a normal gastroscopy or colonoscopy can. Options include push, single-balloon, double-balloon, and spiral enteroscopy. It is used for unexplained gut bleeding, small-bowel Crohn’s, polyps, and small-bowel tumours.
Key facts
Enteroscopy at a glance.
Six practical points that shape whether enteroscopy is the right test — and which technique is chosen.
-
Definition
Deep endoscopic examination of the small bowel.
-
Modalities
Push, single-balloon, double-balloon, spiral.
-
Approach
Antegrade (through mouth) or retrograde (through colon).
-
Capability
Enables biopsy, dilatation, haemostasis.
-
Complements
Capsule endoscopy for lesion localisation.
-
Delivered by
Multi-disciplinary specialist gastro centre.
Preparation
From consultation to recovery — what happens, in order.
Enteroscopy is a longer procedure than standard endoscopy — good preparation makes the day predictable.
- 01
Consultation with advanced endoscopist
A specialist reviews prior imaging, capsule findings and symptoms to plan the approach.
- 02
Bowel prep for retrograde approach
Full colonic preparation if a retrograde per-anal route is planned.
- 03
Fasting per standard endoscopy
Nil by mouth for six hours before an antegrade procedure; clear fluids permitted earlier.
- 04
Sedation or general anaesthesia
Deep sedation or GA — enteroscopy is longer than gastroscopy and requires patient stillness.
- 05
Balloon-assisted or spiral advance
Sequential balloon inflation or spiral overtube pleats the small bowel onto the scope.
- 06
Biopsy or therapy as needed
Tissue sampling, polypectomy, argon plasma coagulation or dilatation performed at the same visit.
- 07
Structured post-procedure care
Recovery on a monitored bay; discharge with written advice and clear escalation route.
What it shows
When enteroscopy is the right test.
Deep enteroscopy answers a specific question — what is happening in the metres of small bowel that standard endoscopy cannot reach.
-
Angiodysplasia
The most common cause of obscure small-bowel bleeding — amenable to endoscopic haemostasis.
-
Small-bowel Crohn’s disease
Direct visualisation and biopsy of jejunal or ileal inflammation beyond the terminal ileum.
-
Small-bowel polyps (Peutz-Jeghers, FAP)
Surveillance and resection of hamartomatous and adenomatous polyps in hereditary syndromes.
-
Small-bowel tumours (GIST, NET)
Localisation and biopsy of gastrointestinal stromal tumours and neuroendocrine lesions.
-
Coeliac disease
Deep duodenal or jejunal biopsy where standard gastroscopy is inconclusive.
-
Meckel’s diverticulum
Endoscopic evaluation when scintigraphy or capsule suggests a diverticular source.
-
Post-surgical anastomosis
Access and inspection of surgically altered anatomy inaccessible to standard endoscopy.
-
Red flag: active bleeding site — endoscopic haemostasis at same procedure
Argon plasma coagulation, clipping or injection therapy delivered during the same session.
Next steps
Treatment options and onward pathways.
What can be done at the same visit — and what routes onward to a specialist team.
-
Argon plasma coagulation for angiodysplasia
Non-contact thermal therapy to seal bleeding vascular lesions in the small bowel.
-
Polypectomy
Snare resection of pedunculated or sessile small-bowel polyps.
-
Balloon dilatation of strictures
Through-the-scope balloon dilatation for Crohn’s or anastomotic strictures.
-
Biopsy for histology
Targeted tissue sampling for inflammation, malignancy or coeliac assessment.
-
Surgical referral for large lesions
Multi-disciplinary handover where lesions are beyond endoscopic resection.
-
Iron replacement for occult bleeding
Intravenous or oral iron alongside endoscopic haemostasis for iron-deficiency anaemia.
-
IBD MDT for Crohn’s
Coordinated gastroenterology, radiology and colorectal review to plan medical therapy.
-
Familial polyposis surveillance
Structured interval enteroscopy for Peutz-Jeghers, FAP and related syndromes.
Red flags
When enteroscopy changes the plan.
Findings and complications that escalate the pathway — surgical review, oncology MDT or genetic assessment.
-
Small-bowel bleeding refractory to endoscopy
Persistent obscure bleeding despite endoscopic therapy warrants angiography or surgery.
-
Small-bowel obstruction
Complete or high-grade obstruction is a contraindication to advancing the scope.
-
Perforation post-procedure
Rare but serious — new severe abdominal pain requires urgent imaging and surgical review.
-
Pancreatitis (rare)
Reported after antegrade enteroscopy due to overtube pressure on the pancreatic duct.
-
Undiagnosed polyposis syndrome
Multiple small-bowel polyps prompt genetic assessment and family screening.
-
Small-bowel adenocarcinoma
Rare but aggressive — early biopsy diagnosis materially changes surgical planning.
-
Neuroendocrine tumour
Requires staging with somatostatin-receptor imaging and specialist NET MDT.
-
Small-bowel lymphoma
Suspicious lesions require deep biopsy and haemato-oncology referral.
-
Post-radiotherapy stricture
Radiation enteritis strictures need cautious dilatation and long-term surveillance.
Sources
Guidelines this page draws on.
- British Society of Gastroenterology.
- European Society of Gastrointestinal Endoscopy.
- American Gastroenterological Association.
- Cochrane reviews on small-bowel endoscopy.
Published 2026-07-30 · Next review 2027-07-30 · Reviewed by Pulse Atlas Editorial Board, .
Frequently asked
Common questions about enteroscopy.
Quick answers on techniques, timing, risks and how enteroscopy relates to capsule endoscopy.
-
What is enteroscopy?
Enteroscopy is a family of endoscopic techniques designed to reach deep into the small bowel — well beyond the duodenum, which standard gastroscopy can access. Options include push enteroscopy, single-balloon, double-balloon and spiral enteroscopy.
-
How is enteroscopy different from a gastroscopy or colonoscopy?
Gastroscopy examines the oesophagus, stomach and duodenum. Colonoscopy examines the colon and terminal ileum. Enteroscopy is designed to examine the metres of small bowel in between — the jejunum and ileum — that neither of those tests can reach.
-
Which enteroscopy technique will I have?
Push enteroscopy is quickest but reaches only the proximal jejunum. Double-balloon and single-balloon enteroscopy allow deeper insertion using inflatable balloons. Spiral enteroscopy uses a rotating overtube. The advanced endoscopist chooses based on the suspected lesion location.
-
How long does enteroscopy take?
Deep enteroscopy is longer than standard endoscopy — typically 60 to 120 minutes depending on the depth required and whether therapy is performed. Sedation or general anaesthesia is used throughout.
-
How does enteroscopy relate to capsule endoscopy?
Capsule endoscopy is often the first test — a swallowed camera that photographs the small bowel. If it identifies a lesion, enteroscopy is then used to biopsy or treat it. The two tests are complementary, not competing.
-
What are the risks of enteroscopy?
The main risks are perforation, bleeding and, rarely, pancreatitis after antegrade procedures. In experienced hands at a specialist centre, serious complications occur in well under one per cent of cases.
Related tests
Looking for a different test?
-
Double-balloon enteroscopy
The deepest small-bowel endoscopy technique.
Learn more -
Capsule endoscopy
A swallowed camera to survey the whole small bowel.
Learn more -
Endoscopy
Standard upper GI endoscopy — oesophagus, stomach, duodenum.
Learn more -
All tests
Browse every test and procedure we arrange.
Learn more -
Hypertension
Related condition guide.
Learn more -
Type 2 Diabetes
Related condition guide.
Learn more -
Cognitive Behaviour Therapy
Related treatment option.
Learn more -
Complementary Alternative Medicine
Related treatment option.
Learn more
In practice, in London
The London pathway for enteroscopy
With enteroscopy, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. Waiting lists on the NHS for enteroscopy vary widely by borough and by how the GP letter reads. Privately in London, we can normally offer a slot inside the same week, sometimes within 48 hours if there’s a cancellation. The difference isn’t clinical quality — the consultants are frequently the same faces you’d see on the NHS — it’s the calendar.
A typical private booking for enteroscopy in London starts with a consultant conversation — sometimes in person on Harley Street or Marylebone, sometimes on video if that suits better. Any imaging or diagnostics happen at a nearby CQC-registered facility, and reports usually land within 24 to 72 hours. The whole loop, from first call to written report, is often done inside a fortnight. For enteroscopy specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
Honesty about expectations is part of the job. A private enteroscopy appointment in London won’t change the underlying medicine — the guidelines, the consultants, and the equipment are largely the same as on the NHS. What it changes is speed, continuity, and the amount of time you get to actually talk through the findings. Everyone we route to is GMC-registered and works within CQC-regulated facilities.