Deep Enteroscopy

Deep enteroscopy is technically challenging and requires a finely honed confluence of skills derived from other endoscopic procedures. Considerable experience in other forms of endoscopy (especially colonoscopy) coupled with specific and comprehensive training in deep enteroscopy is a prerequisite for performing this procedure. Deep enteroscopy is often a therapeutic procedure and as such competence in endoscopic hemostasis is a prerequisite for performing deep enteroscopy. ERCP in the setting of altered anatomy is considerably more difficult than standard ERCP, thus mastery of ERCP is a requisite when contemplating deep enteroscopy-assisted ERCP. The necessary skills for deep enteroscopy are best obtained in a high volume, tertiary referral center. Training of relatively advanced gastroenterology trainees can be achieved in the context of a higher tier training program. Outside the context of a formal training program, training can be achieved by experienced endoscopists who have a complete suite of all the prerequisites. Training in this context can be achieved using a stepwise approach. Initial training is achieved using didactic materials and videos. Following this, hands-on training can be achieved using animal models, followed by supervised procedures.