Post written by Satish S.C. Rao, MD, PhD, from the Digestive Health Center, Department of Medicine, Augusta University, Augusta, Georgia.

Small intestinal bacterial overgrowth (SIBO) is a common yet underrecognized problem. Because symptoms alone are poor predictors of SIBO, diagnostic testing is required. Today, most experts agree, and the recent American College of Gastroenterology guidelines further endorsed that small-bowel aspiration and culture is currently the best technique for identifying SIBO. Its limitations include invasiveness, cost, lack of standardization of aspiration and microbiological techniques, and need for collaboration with the microbiology laboratory. Here we describe our technique of small-bowel aspiration to bridge the knowledge gap, so that more endoscopists can adopt this technology and facilitate a proper diagnosis of SIBO.       

The diagnosis of SIBO has been challenging, and commonly used breath tests are not standardized or yield false positive results. Likewise, small-bowel aspiration is not standardized, and most endoscopists are either unfamiliar with or not trained in this technique. Further, there are multiple challenges such as instrument contamination, aspirating an adequate sample, and air insufflation all of which can affect the test results. Without aseptic technique one cannot guarantee accuracy of test results. To improve the quality of sample collected, it is necessary to follow a standardize procedure. This video showcases a time-tested method of how to collect a good aspirate sample for accurate diagnosis of SIBO. We describe a pragmatic approach for duodenal aspirate/culture. Once familiar with the technique most endoscopists can perform this test in endo lab.      

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