Complete anterograde small-bowel exploration with the novel motorized spiral enteroscope

The evolving role of device-assisted enteroscopy: The state of the art as of August 2023

Device-assisted enteroscopy (DAE), balloon-assisted enteroscopy (BAE) in particular, has become a routine endoscopic procedure which has revolutionized our approach to small-bowel disease. Evidence demonstrating the efficacy and safety of BAE spans over 22-years of experience, making it an established pillar of minimally invasive care. The robust evidence for BAE's safety and efficacy has now been incorporated into international clinical guidelines, technical reviews, benchmarking performance measures and curricula. The more recently introduced motorized spiral enteroscopy (MSE) which had replaced the previous manual version, abruptly ended its 7-year stint in clinical practice, when it was withdrawn and recalled from the market by its manufacturing company in July 2023, due to several associated serious adverse events (including fatalities). This article, written by the original developer of double-balloon enteroscopy (DBE) and other recognized international experts and pioneers in this field, focuses mainly on the technical aspects, evolving indications, and equipment-related technological advances. Despite the very recent withdrawal of MSE from clinical practice, for completeness, this technology and its technique is still briefly covered here, albeit importantly, along with a short description of reported, associated, serious adverse events which have contributed to its withdrawal/recall from the market and clinical practice.

Power Spiral Enteroscopy: A Quick and Powerful Dive Deep Inside the Small Bowel!

A comprehensive and detailed small bowel evaluation became possible since 2001 with the advent of a wireless capsule endoscope that was primarily used for diagnostic purposes. Simultaneously, the development of balloon-assisted enteroscope made detailed evaluation and therapy possible in the deeper small bowel. A novel motorized spiral enteroscope, introduced in 2015, is the most recent addition to the list of device-assisted enteroscopes. The rotational movements of the spiral overtube controlled by the integrated motor are transmitted into a linear force causing forward and backward propulsion of the scope in the bowel. There is emerging evidence about its safety and efficacy in the diagnosis and therapy of various small bowel diseases.