Subscribe to RSS
The performance and safety of motorized spiral enteroscopy, including in patients with surgically altered gastrointestinal anatomy: a multicenter prospective studyTrial Registration: ClinicalTrials.gov Registration number (trial ID): NCT04884113 Type of study: Prospective Multicenter Study
Background Data are scarce on the efficacy and safety of motorized spiral enteroscopy (MSE). No data are available on the utility of this technique in patients with surgically altered gastrointestinal (GI) anatomy. We aimed to evaluate the safety and efficacy of MSE in patients with suspected small-bowel disease, including those with surgically altered GI anatomy.
Methods A multicenter prospective observational, uncontrolled study evaluated MSE in consecutive patients with suspected small-bowel pathology and an indication for diagnostic and/or therapeutic intervention.
Results A total of 170 patients (102 men; median age 64 years, range 18–89) were included. The overall diagnostic yield was 64.1 %. Endotherapy was performed in 53.5 % of procedures. The median total procedure times for the antegrade and retrograde approaches were 45 minutes (interquartile range [IQR] 30–80) and 40 minutes (IQR 30–70), respectively. When total (pan)enteroscopy was intended, this was achieved at rate of 70.3 % (28.1 % by antegrade approach and 42.2 % by a bidirectional approach). Surgically altered GI anatomy was present in 34 /170 of all procedures (20.0 %) and in 11 /45 of the successful total enteroscopy procedures (24.4 %). Propofol sedation or general anesthesia were used in 92.9 % and 7.1 % of the procedures, respectively. Minor adverse events were observed in 15.9 % of patients, but there were no major adverse events.
Conclusion MSE seems to be an effective and safe endoscopic procedure. Total (pan)enteroscopy can be achieved, in one or two sessions, even in the presence of surgically altered GI anatomy. The total procedure time is relatively short. For both antegrade and retrograde MSE procedures, propofol sedation seems sufficient and safe.
Received: 21 October 2021
Accepted after revision: 28 February 2022
Accepted Manuscript online:
28 February 2022
Article published online:
06 May 2022
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Schneider M, Höllerich J, Beyna T. Device-assisted enteroscopy: A review of available techniques and upcoming new technologies. World J Gastroenterol 2019; 25: 3538-3545
- 2 Yamamoto H, Kita H. Enteroscopy. J Gastroenterol 2005; 40: 555-562
- 3 Akerman PA, Agrawal D, Chen W. et al. Spiral enteroscopy: a novel method of enteroscopy by using the Endo-Ease Discovery SB overtube and a pediatric colonoscope. Gastrointest Endosc 2009; 69: 327-332
- 4 Heine GD, Al-Toma A, Mulder CJJ. et al. Milestone in gastrointestinal endoscopy: double-balloon enteroscopy of the small bowel. Scand J Gastroenterol 2006; 243: S32-S38
- 5 Rahmi G, Samaha E, Vahedi K. et al. Multicenter comparison of double-balloon enteroscopy and spiral enteroscopy. J Gastroenterol Hepatol 2013; 28: 992-998
- 6 Neuhaus H, Beyna T, Schneider M. et al. Novel motorized spiral enteroscopy: first clinical case. VideoGIE 2016; 1: 32-33
- 7 Ramchandani M, Rughwani H, Inavolu P. et al. Diagnostic yield and therapeutic impact of novel motorized spiral enteroscopy in small-bowel disorders: a single-center, real-world experience from a tertiary care hospital (with video). Gastrointest Endosc 2021; 93: 616-626
- 8 Beyna T, Arvanitakis M, Schneider M. et al. Motorised spiral enteroscopy: First prospective clinical feasibility study. Gut 2021; 70: 261-267
- 9 Inavolu P, Singh AP, Kanakagiri H. et al. Motorized spiral enteroscope-assisted retrieval of video capsule in a patient with Crohn’s disease. VideoGIE 2020; 5: 488-491
- 10 Beyna T, Arvanitakis M, Schneider M. et al. Total motorized spiral enteroscopy: first prospective clinical feasibility trial. Gastrointest Endosc 2021; 93: 1362-1370
- 11 Tang RSY, Wong MTL, Lai JCT. et al. Total enteroscopy by antegrade motorized spiral enteroscopy under conscious sedation for acute overt obscure gastrointestinal bleeding. Endoscopy 2020; 52: E251-E252
- 12 Rondonotti E, Spada C, Adler S. et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2018; 50: 423-446
- 13 Irfan M, Ahmed M, Breen D. Assessment of high flow nasal cannula oxygenation in endobronchial ultrasound bronchoscopy: a randomized controlled trial. J Bronchol Interv Pulmonol 2021; 28: 130-137
- 14 Miguel-Montanes R, Hajage D, Messika J. et al. Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia. Crit Care Med 2015; 43: 574-583
- 15 Baniya R, Upadhaya S, Subedi SC. et al. Balloon enteroscopy versus spiral enteroscopy for small-bowel disorders: a systematic review and meta-analysis. Gastrointest Endosc 2017; 86: 997-1005
- 16 May A, Manner H, Aschmoneit I. et al. Prospective, cross-over, single-center trial comparing oral double-balloon enteroscopy and oral spiral enteroscopy in patients with suspected small-bowel vascular malformations. Endoscopy 2011; 43: 477-4833
- 17 Xin L, Liao Z, Jiang YP. et al. Indications, detectability, positive findings, total enteroscopy, and complications of diagnostic double-balloon endoscopy: A systematic review of data over the first decade of use. Gastrointest Endosc 2011; 74: 563-570
- 18 Upchurch BR, Sanaka MR, Lopez AR. et al. The clinical utility of single-balloon enteroscopy: a single-center experience of 172 procedures. Gastrointest Endosc 2010; 71: 1218-1223
- 19 Khashab MA, Lennon AM, Dunbar KB. et al. A comparative evaluation of single-balloon enteroscopy and spiral enteroscopy for patients with mid-gut disorders. Gastrointest Endosc 2010; 72: 766-772
- 20 Morgan D, Upchurch B, Draganov P. et al. Spiral enteroscopy: prospective U.S. multicenter study in patients with small-bowel disorders. Gastrointest Endosc 2010; 72: 992-998
- 21 Moran RA, Barola S, Law JK. et al. A randomized controlled trial comparing the depth of maximal insertion between anterograde single-balloon versus spiral enteroscopy. Clin Med Insights Gastroenterol 2018; 11 DOI: 10.1177/1179552218754881.
- 22 May A, Färber M, Aschmoneit I. et al. Prospective multicenter trial comparing push-and-pull enteroscopy with the single- and double-balloon techniques in patients with small-bowel disorders. Am J Gastroenterol 2010; 105: 575-581
- 23 Lenz P, Domagk D. Double- vs. single-balloon vs. spiral enteroscopy. . Best Pract Res Clin Gastroenterol 2012; 26: 303-313
- 24 Takano N, Yamada A, Watabe H. et al. Single-balloon versus double-balloon endoscopy for achieving total enteroscopy: A randomized, controlled trial. Gastrointest Endosc 2011; 73: 734-739
- 25 Yamamoto H, Yano T, Ohmiya N. et al. Double-balloon endoscopy is safe and effective for the diagnosis and treatment of small-bowel disorders: Prospective multicenter study carried out by expert and non-expert endoscopists in Japan. Dig Endosc 2015; 27: 331-337
- 26 Ramchandani M, Reddy DN, Gupta R. et al. Diagnostic yield and therapeutic impact of single-balloon enteroscopy: Series of 106 cases. J Gastroenterol Hepatol 2009; 24: 1631-1638