Endoscopy 2009; 41(3): 194-199
DOI: 10.1055/s-0028-1119602
Original article

© Georg Thieme Verlag KG Stuttgart · New York

The spiral enteroscopy training initiative: results of a prospective study evaluating the Discovery SB overtube device during small bowel enteroscopy (with video)

J.  M.  Buscaglia1 , 2 , K.  B.  Dunbar1 , P.  I.  Okolo1  III , J.  Judah3 , P.  A.  Akerman4 , D.  Cantero5 , P.  V.  Draganov3
  • 1Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
  • 2Department of Medicine, State University of New York, Stony Brook University Medical Center, Stony Brook, New York, USA
  • 3Department of Medicine, University of Florida School of Medicine, Shands Hospital, Gainesville, Florida, USA
  • 4Department of Medicine, Brown University School of Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
  • 5Department of Medicine, Hospital Privado Frances, Asuncion, Paraguay
Further Information

Publication History

submitted29 July 2008

accepted after revision3 December 2008

Publication Date:
11 March 2009 (online)

Background and aim: Indications for small-bowel enteroscopy are increasing, but advancing the endoscope to the ileum remains challenging, especially for less experienced operators. The aim was to evaluate the ease of use, safety, and efficacy of the Discovery SB overtube (Spirus Medical, Stoughton, Massachusetts, USA) during SB enteroscopy by physicians with no experience of the device.

Patients and methods: Thirty-three ”untrained“ endoscopists performed spiral enteroscopy during one of four 2-day training modules. Data were prospectively collected. Patient demographics, depth and time to maximal insertion, total procedure time, and findings were recorded. Trauma was documented during scope withdrawal. Day 1 and day 2 results were compared.

Results: Ninety procedures were successfully performed in 95 patients (72.6 % women, age = 48.8 ± 14.2 years). Endoscopists each performed a mean of five procedures. Mean time to maximal insertion was 20.9 ± 6.4 minutes. Mean depth achieved was 262.0 ± 57.4 cm. Total procedure time was 33.6 ± 8.0 minutes. In 90.3 %, 94.6 %, and 83.9 % of patients, respectively, a trauma score less than 3 was recorded in the esophagus, stomach, and intestine (scale = 0 – 5). There were no perforations, nor significant associations between trauma score and patient age, body mass index, depth of insertion, time to maximal insertion, total procedure time, or day 1 vs. day 2 procedures. Depth of insertion was greater on day 2 than on day 1 (276.9 ± 53.7 cm vs. 252.0 ± 58.0 cm, P = 0.043).

Conclusions: Discovery SB provides safe advancement of the enteroscope into the distal small bowel. Maximum depth of insertion appears comparable to that of balloon enteroscopy while taking less time. The device is easy to use and may be effectively operated in as few as five training cases.


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J. M. BuscagliaMD 

State University of New York at Stony Brook
Stony Brook University Medical Center
Health Sciences Center (HSC)

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Room 060
Stony Brook
NY 11794

Fax: +1-631-4448886

Email: jmbuscaglia@notes.cc.sunysb.edu