First report of complete enteroscopy from ileocecal valve to pylorus by retrograde motorized power spiral endoscopy

Abstract

The development of capsule endoscopy and device-assisted enteroscopy (DAE) revolutionized minimally invasive examination and treatment of small bowel diseases. Limitations of DAE are a great time expenditure and low rates of complete enteroscopy. Recently motorized spiral enteroscopy (MSE) was introduced with shorter procedure times and concurrently greater insertion depths. MSE is also the first device that opens up the possibility to achieve complete enteroscopy in a relevant number of cases by the unidirectional, peroral approach.

To our knowledge we present the first published case of complete enteroscopy by retrograde MSE in a 35-year-old female without prior abdominal surgery with direct endoscopic visualization of the pyloric ring. The patient suffered from colonic polyposis syndrome. For the exploration of both colorectum and the small bowel we performed retrograde MSE under propofol sedation. After 60 minutes of advancement, we achieved complete enteroscopy by retrograde identification of the pyloric ring. The procedure could be finished after withdrawal of the endoscope and cold snare polypectomy of 3 small colonic adenomas without any adverse events. Total procedure time was 82 minutes. The patient was discharged one day after the procedure without complaints.

It has been proven already that great insertion depths are achievable by retrograde MSE, but this case shows for the first time that even a complete enteroscopy is possible. In conclusion, primary retrograde MSE with no need of tracheal intubation might be a key to more effective, time-preserving, and cost-effective concepts of small-bowel endoscopy in the future.

Zusammenfassung

Die Entwicklung der Videokapsel und Device-assisted Enteroskopie (DAE) hat die minimal-invasive Diagnostik und Therapie von Dünndarmerkrankungen revolutioniert. Limitationen der DAE sind der große Zeitaufwand und die niedrigen totalen Enteroskopieraten. Kürzlich wurde die motorisierte Spiralenteroskopie (MSE) eingeführt, die kürzere Untersuchungszeiten bei zugleich höheren Eindringtiefen ermöglicht. MSE ist ferner das erste System, das die Möglichkeit eröffnet, in einer relevanten Anzahl von Fällen eine komplette unidirektionale, perorale Enteroskopie durchzuführen.

Nach unserem Wissen beschreiben wir den ersten Fall einer kompletten Enteroskopie durch eine retrograde MSE bei einer 35-jährigen Frau ohne abdominelle Voroperationen mit Erreichen des pylorischen Rings. Grunderkrankung war eine Polyposis coli. Um in einer Sitzung das Kolorektum und den Dünndarm untersuchen zu können, führten wir eine peranale MSE in Propofol-Sedierung durch. Nach 60 Minuten des Vorspiegelns wurde eine komplette Enteroskopie erreicht, bestätigt durch retrograde, endoskopische Darstellung des Pylorus. Nach dem Zurückspiegeln und der Resektion von 3 kleinen Kolonpolypen mit der kalten Schlinge konnte der Eingriff komplikationslos beendet werden. Die komplette Eingriffszeit betrug 82 Minuten. Die Patientin konnte am Folgetag beschwerdefrei entlassen werden.

Es wurde bereits gezeigt, dass hohe Insertionstiefen durch retrograde MSE möglich sind, aber dieser Fall demonstriert zum ersten Mal, dass auf diesem Wege sogar eine komplette Enteroskopie durchgeführt werden kann. Zusammenfassend könnte der primär retrograde Zugang unter Verzicht auf eine Intubationsnarkose einen Schlüssel zur effektiveren, zeitsparenderen und kostengünstigeren Dünndarmendoskopie darstellen.

Schlüsselwörter

Motorisierte Spiralenteroskopie - Device-assisted Enteroskopie - Ballonenteroskopie - Push and Pull-Enteroskopie - Familiäre Adenomatöse Polyposis (FAP) - gastrointestinale Blutung - Dünndarmblutung

Keywords

Motorized Spiral Enteroscopy - Device-assisted Enteroscopy - Balloon Enteroscopy - Push and Pull Enteroscopy - Familial Adenomatous polyposis (FAP) - gastrointestinal bleeding - small bowel bleeding

Publication History

Received: 18 July 2022

Accepted after revision: 16 September 2022

Article published online:
07 November 2022

• References

• 1 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 DOI: 10.1016/j.gie.2011.03.1239. (PMID: 21620401)
• 2 Messer I, May A, Manner H. et al. Prospective, randomized, single-center trial comparing double-balloon enteroscopy and spiral enteroscopy in patients with suspected small-bowel disorders. Gastrointest Endosc 2013; 77: 241-249 DOI: 10.1016/j.gie.2012.08.020. (PMID: 23043851)
• 3 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 DOI: 10.1111/den.12378. (PMID: 25180488)
• 4 Pennazio M, Spada C, Eliakim R. et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2015; 47: 352-376 DOI: 10.1055/s-0034-1391855. (PMID: 25826168)
• 5 Beyna T, Arvanitakis M, Schneider M. et al. Total motorized spiral enteroscopy: first prospective clinical feasibility trial. Gastrointest Endosc 31.10.2020; DOI: 10.1016/j.gie.2020.10.028. (PMID: 33144239)
• 6 Al-Toma A, Beaumont H, Koornstra JJ et al. The performance and safety of motorized spiral enteroscopy including patients with surgical altered gastrointestinal anatomy: a multicenter prospective study 2022.
• 7 Beyna T, Arvanitakis M, Schneider M. et al. Motorised spiral enteroscopy: first prospective clinical feasibility study. Gut 2021; 70: 261-267 DOI: 10.1136/gutjnl-2019-319908. (PMID: 32332141)
• 8 Beyna T, Moreels T, Arvanitakis M. et al. Motorized spiral enteroscopy: results of an international multicenter prospective observational clinical study in patients with normal and altered gastrointestinal anatomy. Endoscopy 23.06.2022; DOI: 10.1055/a-1831-6215.
• 9 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: 477-483 DOI: 10.1055/s-0030-1256340. (PMID: 21437852)
• 10 Su MY, Lin WP, Chu CT. Experience of double balloon enteroscopy. J Chin Med Ass 2018; 81: 225-229 DOI: 10.3390/diagnostics12092224. (PMID: 36140625)
• 11 Beyna T, Schneider M, Pullmann D. et al. Motorized spiral colonoscopy: a first single-center feasibility trial. Endoscopy 2018; 50: 518-523 DOI: 10.1055/s-0043-123577. (PMID: 29253918)
• 12 Akerman PA, Cantero D. Severe complications of spiral enteroscopy in the first 1750 patients. Gastrointest Endosc 2009; 69: AB127
• 13 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 (03) 616-626 DOI: 10.1016/j.gie.2020.07.001. (PMID: 32663489)
• 14 Buchholz H, Mende M, Hornoff S. et al. Results of motorized spiral enteroscopy in 83 consecutive patients. Z Gastroenterol 17.02.2022; DOI: 10.1055/a-1744-6738.. (PMID: 35176807)
• 15 Prasad M, Sangameswaran A, Murthy V. et al. A spiraling journey into the small bowel: a case series of novel motorized power spiral enteroscopies. VideoGIE 04.11.2020; 5 (11) 591-596 DOI: 10.1016/j.vgie.2020.08.001. (PMID: 33204928)
• 16 Singh P, Singla V, Bopanna S. et al. Safety and efficacy of the novel motorized power spiral enteroscopy: A single-center experience. DEN open 11.06.2022; 3 (01) e148 DOI: 10.1002/deo2.148.. (PMID: 35898825)