Muscarella Lawrence F
Research and Development, Custom Ultrasonics, Inc., Ivyland, Pennsylvania 18974, USA.
Gastroenterol Nurs. 2007 Mar-Apr;30(2):109-15. doi: 10.1097/01.SGA.0000267931.51995.86.
Failure to identify and diagnose the site and cause of obscure bleeding or some other gastrointestinal disorder may be an indication for push enteroscopy. During this procedure, a long, narrow, flexible gastrointestinal endoscope, known as a push enteroscope, is advanced into the upper gastrointestinal tract to examine and evaluate the proximal section (first one third) of the small bowel. Because of limited funding and inadequate instrument availability, some gastrointestinal endoscopy units may perform this procedure using a colonoscope instead of a push enteroscope. Although not specifically designed for push enteroscopy, colonoscopes are less expensive than push enteroscopes and readily available for clinical use in virtually every gastrointestinal endoscopy unit. The use of a colonoscope or other lower gastrointestinal endoscope to perform push enteroscopy or another upper gastrointestinal procedure (or the use of an upper gastrointestinal endoscope to perform a lower gastrointestinal procedure) is defined in this article as endoscopic shuffling. Although it is arguably efficient and cost effective (and in some instances may improve clinical outcomes), endoscopic shuffling raises a number of economic, legal, medical, and ethical questions and concerns, several of which are discussed in this article, with a particular focus on infection control.
未能识别和诊断不明原因出血或其他一些胃肠道疾病的部位及病因，可能是进行推进式小肠镜检查的指征。在该检查过程中，一种长而窄的可弯曲胃肠道内镜，即推进式小肠镜，被推进到上消化道，以检查和评估小肠的近端部分（前三分之一）。由于资金有限且仪器供应不足，一些胃肠道内镜检查单位可能会使用结肠镜而非推进式小肠镜来进行此检查。尽管结肠镜并非专门为推进式小肠镜检查设计，但它比推进式小肠镜便宜，且几乎在每个胃肠道内镜检查单位都可随时用于临床。本文将使用结肠镜或其他下消化道内镜进行推进式小肠镜检查或其他上消化道检查（或使用上消化道内镜进行下消化道检查）定义为内镜混用。尽管内镜混用可以说是高效且具有成本效益的（在某些情况下可能改善临床结果），但它引发了一些经济、法律、医学和伦理问题及担忧，本文将讨论其中的几个问题，特别关注感染控制。
