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Nabi Z, Samanta J, Chavan R, Dhar J, Hussain S, Singh AP, Rughwani H, Reddy DN. Role of Novel Motorized Enteroscopy in the Evaluation of Small Bowel Diseases: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2024; 58:349-359. [PMID: 37279281 DOI: 10.1097/mcg.0000000000001862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/08/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND AIM Motorized spiral enteroscopy (MSE) has recently been introduced for small bowel evaluation. In this systematic review and meta-analysis, we aim to evaluate the safety and efficacy of MSE for evaluation of small bowel diseases. METHODS A literature search was performed in Embase, PubMed, Medline databases for studies evaluating MSE between January -2010 and October-2022. The primary outcome of the study was diagnostic yield with MSE. Secondary outcomes included technical success, procedure duration, depth of maximum insertion (DMI), rate of pan-enteroscopy and adverse events. RESULTS 10 studies with 961 patients [581 (60.5%) males] were included in the analysis. 1068 MSE procedures were performed by antegrade route in 698, retrograde route in 215 and bidirectional in 155 patients. Technical success was achieved in 94.9% (95% CI 92.9% to 96.4%) procedures. The pooled diagnostic yield of MSE was 73.7% (95% CI 70.7% to 76.4%). Pooled rate of pan-enteroscopy by antegrade route was 21.9% (95% CI 18.1% to 26.1%), retrograde route was 6.9% (95% CI 2.4% to 18.3%) and combined route was 61.2% (95% CI 52.4% to 69.3%). Pooled rate of major adverse events was 1.9% (95% CI 1.2% to 3.2%). CONCLUSIONS MSE is a safe and effective tool for evaluating small bowel disorders. High diagnostic yield and low rate of adverse events make it a potential alternative to balloon enteroscopy. However, comparative trials are required in the future.
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Affiliation(s)
- Zaheer Nabi
- Asian Institute of Gastroenterology, Hyderabad
| | | | - Radhika Chavan
- Department of Gastroenterology, Asian institute of Gastroenterology, Hyderabad
| | | | - Sabir Hussain
- Department of Gastroenterology, Dr SN Medical College, Jodhpur
| | | | - Hardik Rughwani
- Department of Gastroenterology, Asian Iinstitute of Gastroenterology, Hyderabad
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Wiedbrauck D, Wiedbrauck F, Freund U, Rodenberg F, Prenzel J, Hollerbach S. Spontaneous detachment of the spiral overtube from the endoscope in the upper esophagus: a case report and literature review of a rare complication during motorized spiral enteroscopy. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:407-411. [PMID: 37044124 DOI: 10.1055/a-2053-9238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Motorized spiral enteroscopy (MSE) is a recent modality for diagnostic and therapeutic examination of the small bowel using a spiral-shaped overtube with an integrated electric motor attached to an endoscope. With growing evidence of its efficacy, MSE is increasingly being used by endoscopic facilities. We herein present an uncommon case of the detachment of the spiral overtube from the endoscope during MSE. CASE REPORT We performed antegrade MSE in a 75-year-old female under general anesthesia for coagulation of multiple small-bowel arteriovenous malformations and resection of a polyp detected on a previous capsule endoscopy. The management was successful, and we had no passage difficulties. However, during the withdrawal phase of the enteroscope, the entire spiral overtube disconnected from the endoscopic shaft and became stuck in the esophagus and pharynx. Attempts to remove the lodged spiral using various endoscopic forceps, graspers, snares, or a dilatation balloon failed. Also, the laryngoscopic use of Magill forceps did not allow grabbing the spiral properly. Eventually, the spiral could be retrieved laryngoscopically with arthroscopic grasping forceps. This incident caused laryngeal swelling and bleeding lacerations of the upper esophagus, which were clipped on a subsequent gastroscopy. No further long-lasting complications occurred in the patient. CONCLUSION Detachment of the spiral from the enteroscope is a potentially life-threatening and challenging complication of MSE. Artificial ventilation under observation by an anesthesiologist allowed for calm management of this dangerous situation and increased the overall safety of the procedure. Hence, we believe that in the context of antegrade MSE, general anesthesia with endotracheal intubation should be mandatory.
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Affiliation(s)
- Damian Wiedbrauck
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
| | - Felix Wiedbrauck
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
| | - Ulrich Freund
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
| | - Frauke Rodenberg
- Department of Anesthesiology and Intensive Care Medicine, Allgemeines Krankenhaus Celle, Celle, Germany
| | - Jens Prenzel
- Department of Anesthesiology and Intensive Care Medicine, Allgemeines Krankenhaus Celle, Celle, Germany
| | - Stephan Hollerbach
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
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3
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Shiha MG, Sidhu R, Lucaciu LA, Palmer-Jones C, Ayeboa-Sallah B, Lazaridis N, Eckersley R, Hiner GE, Maxfield D, Shaheen W, Abduljabbar D, Hussain MA, O'Hare R, Phull PS, Eccles J, Caddy GR, Butt MA, Kurup A, Chattree A, Hoare J, Jennings J, Longcroft-Wheaton G, Collins P, Humphries A, Murino A, Despott EJ, Sanders DS. Device-assisted enteroscopy performance measures in the United Kingdom: DEEP-UK quality improvement project. Endoscopy 2024; 56:174-181. [PMID: 37949103 DOI: 10.1055/a-2199-7155] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Device-assisted enteroscopy (DAE) has become a well-established diagnostic and therapeutic tool for the management of small-bowel pathology. We aimed to evaluate the performance measures for DAE across the UK against the quality benchmarks proposed by the European Society of Gastrointestinal Endoscopy (ESGE). METHODS We retrospectively collected data on patient demographics and DAE performance measures from electronic endoscopy records of consecutive patients who underwent DAE for diagnostic and therapeutic purposes across 12 enteroscopy centers in the UK between January 2017 and December 2022. RESULTS A total of 2005 DAE procedures were performed in 1663 patients (median age 60 years; 53% men). Almost all procedures (98.1%) were performed for appropriate indications. Double-balloon enteroscopy was used for most procedures (82.0%), followed by single-balloon enteroscopy (17.2%) and spiral enteroscopy (0.7%). The estimated depth of insertion was documented in 73.4% of procedures. The overall diagnostic yield was 70.0%. Therapeutic interventions were performed in 42.6% of procedures, with a success rate of 96.6%. Overall, 78.0% of detected lesions were marked with a tattoo. Patient comfort was significantly better with the use of deep sedation compared with conscious sedation (99.7% vs. 68.5%; P<0.001). Major adverse events occurred in only 0.6% of procedures. CONCLUSIONS Performance measures for DAE in the UK meet the ESGE quality benchmarks, with high diagnostic and therapeutic yields, and a low incidence of major adverse events. However, there is room for improvement in optimizing sedation practices, standardizing the depth of insertion documentation, and adopting marking techniques to aid in the follow-up of detected lesions.
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Affiliation(s)
- Mohamed G Shiha
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom of Great Britain and Northern Ireland
- Division of Clinical Medicine, School of Medicine and Population Health, The University of Sheffield, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Reena Sidhu
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom of Great Britain and Northern Ireland
- Division of Clinical Medicine, School of Medicine and Population Health, The University of Sheffield, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Laura A Lucaciu
- Royal Free Unit for Endoscopy, The Royal Free Hospital, University College London Institute for Liver and Digestive Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Christopher Palmer-Jones
- Royal Free Unit for Endoscopy, The Royal Free Hospital, University College London Institute for Liver and Digestive Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Benjamin Ayeboa-Sallah
- Royal Free Unit for Endoscopy, The Royal Free Hospital, University College London Institute for Liver and Digestive Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Nikolaos Lazaridis
- Royal Free Unit for Endoscopy, The Royal Free Hospital, University College London Institute for Liver and Digestive Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Robert Eckersley
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - George E Hiner
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Dominic Maxfield
- Department of Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom of Great Britain and Northern Ireland
| | - Walaa Shaheen
- Department of Gastroenterology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland
| | - Duaa Abduljabbar
- Department of Gastroenterology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland
| | - Muhammad A Hussain
- Directorates of Endoscopy and Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Rosie O'Hare
- Division of Gastroenterology, Ulster Hospital, Dundonald, United Kingdom of Great Britain and Northern Ireland
| | - Perminder S Phull
- Department of Digestive Disorders, Aberdeen Royal Infirmary, Aberdeen, United Kingdom of Great Britain and Northern Ireland
| | - John Eccles
- Division of Gastroenterology, Ulster Hospital, Dundonald, United Kingdom of Great Britain and Northern Ireland
| | - Grant R Caddy
- Division of Gastroenterology, Ulster Hospital, Dundonald, United Kingdom of Great Britain and Northern Ireland
| | - Mohammed A Butt
- Directorates of Endoscopy and Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Arun Kurup
- Department of Gastroenterology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom of Great Britain and Northern Ireland
| | - Amit Chattree
- Department of Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom of Great Britain and Northern Ireland
| | - Jonathan Hoare
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Jason Jennings
- Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - Gaius Longcroft-Wheaton
- Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom of Great Britain and Northern Ireland
| | - Paul Collins
- Department of Gastroenterology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Adam Humphries
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital, University College London Institute for Liver and Digestive Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital, University College London Institute for Liver and Digestive Health, London, United Kingdom of Great Britain and Northern Ireland
| | - David S Sanders
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom of Great Britain and Northern Ireland
- Division of Clinical Medicine, School of Medicine and Population Health, The University of Sheffield, Sheffield, United Kingdom of Great Britain and Northern Ireland
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Dray X, Leenhardt R, Camus M. Stuck in a Hard Place: Salvage, Manual Withdrawal of a Motorized Spiral Overtube Out of the Esophagus and Pharynx. J Clin Gastroenterol 2024; 58:103-105. [PMID: 37646534 DOI: 10.1097/mcg.0000000000001908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Xavier Dray
- Sorbonne University, Centre for Digestive Endoscopy, Saint-Antoine Hospital, APHP Paris, France
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Funayama Y, Shinozaki S, Yano T, Yamamoto H. Advancements in endoscopic management of small-bowel polyps in Peutz-Jeghers syndrome and familial adenomatous polyposis. Therap Adv Gastroenterol 2023; 17:17562848231218561. [PMID: 38164364 PMCID: PMC10757794 DOI: 10.1177/17562848231218561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024] Open
Abstract
Before the development of double-balloon enteroscopy (DBE), the standard management of small-bowel polyposis was surgical resection. This is an invasive procedure that could lead to short bowel syndrome. In the 21st century, several new enteroscopy techniques were distributed worldwide, including DBE, single-balloon enteroscopy, spiral enteroscopy, and motorized spiral enteroscopy. These devices enable the diagnoses and endoscopic interventions in the entire small bowel, even in patients with a history of laparotomy. In patients with Peutz-Jeghers syndrome (PJS), endoscopic ischemic polypectomy with clips or a detachable snare is the preferred method for managing pedunculated polyps because it is less likely to cause adverse events than conventional polypectomy. Although polyps in patients with PJS always recur, repeat endoscopic resection can reduce the total number and mean size of polyps in the long-term clinical course. Endoscopic reduction of small-bowel intussusception caused by PJS polyps can be successfully performed using DBE without surgery. A transparent hood is useful for securing a visual field during the treatment of small-bowel polyps, and minimal water exchange method is recommended to facilitate deep insertion. Familial adenomatous polyposis (FAP) is a genetic disorder that increases the risk of developing colorectal cancer. Because jejunal and ileal polyps in patients with FAP have the potential to develop into cancer via the adenoma-carcinoma sequence, periodical surveillance, and endoscopic resection are needed for them, not only polyps in the duodenum. In cases of multiple small-bowel polyps in patients with FAP, cold snare polypectomy without retrieval is an acceptable treatment option for polyps that are 10 mm or smaller in size. Additional good pieces of evidence are necessary to confirm these findings because this narrative review mostly includes retrospective observational studies from single center, case reports, and expert reviews.
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Affiliation(s)
- Yohei Funayama
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Satoshi Shinozaki
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
- Shinozaki Medical Clinic, Utsunomiya, Tochigi, Japan
| | - Tomonori Yano
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hironori Yamamoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
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Mulki R, Qayed E, Yang D, Chua TY, Singh A, Yu JX, Bartel MJ, Tadros MS, Villa EC, Lightdale JR. The 2022 top 10 list of endoscopy topics in medical publishing: an annual review by the American Society for Gastrointestinal Endoscopy Editorial Board. Gastrointest Endosc 2023; 98:1009-1016. [PMID: 37977661 DOI: 10.1016/j.gie.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/09/2023] [Accepted: 08/29/2023] [Indexed: 11/19/2023]
Abstract
Using a systematic literature search of original articles published during 2022 in Gastrointestinal Endoscopy and other high-impact medical and gastroenterology journals, the 10-member Editorial Board of the American Society for Gastrointestinal Endoscopy composed a list of the 10 most significant topic areas in GI endoscopy during the study year. Each Editorial Board member was directed to consider 3 criteria in generating candidate lists-significance, novelty, and global impact on clinical practice-and subject matter consensus was facilitated by the Chair through electronic voting. The 10 identified areas collectively represent advances in the following endoscopic spheres: artificial intelligence, endoscopic submucosal dissection, Barrett's esophagus, interventional EUS, endoscopic resection techniques, pancreaticobiliary endoscopy, management of acute pancreatitis, endoscopic environmental sustainability, the NordICC trial, and spiral enteroscopy. Each board member was assigned a consensus topic area around which to summarize relevant important articles, thereby generating this précis of the "top 10" endoscopic advances of 2022.
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Affiliation(s)
- Ramzi Mulki
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emad Qayed
- Division of Digestive Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Dennis Yang
- Center of Interventional Endoscopy (CIE) Advent Health, Orlando, Florida, USA
| | - Tiffany Y Chua
- Division of Digestive Diseases, Harbor-University of California Los Angeles, Torrance, California, USA
| | - Ajaypal Singh
- Division of Digestive Diseases and Nutrition, Rush University Medical Center, Chicago, Illinois, USA
| | - Jessica X Yu
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Edward C Villa
- NorthShore University Health System, Chicago, Illinois, USA
| | - Jenifer R Lightdale
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
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7
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Li P, Wang Y. The route of anterograde and retrograde matters in motorized spiral enteroscopy. Gastrointest Endosc 2023; 98:874-875. [PMID: 37863575 DOI: 10.1016/j.gie.2023.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Peiwen Li
- Department of Thoracic Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Yizi Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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8
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Rughwani H, Singh AP, Ramchandani M, Jagtap N, Pal P, Inavolu P, Reddy PM, Januszewicz W, Sekaran A, Nabi Z, Patel R, Lakhtakia S, Banerjee R, Memon SF, Balram P, Darishetty S, Rao GV, Reddy DN. A Randomized, Controlled Trial Comparing the Total Enteroscopy Rate and Diagnostic Efficacy of Novel Motorized Spiral Enteroscopy and Single-Balloon Enteroscopy in Patients With Small-Bowel Disorders: The Motor Trial (NCT 05548140). Am J Gastroenterol 2023; 118:1855-1863. [PMID: 37463435 DOI: 10.14309/ajg.0000000000002409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/21/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Device-assisted enteroscopy has revolutionized the management of small-bowel disorders (SBD). No study to date has compared both novel motorized spiral enteroscopy (NMSE) and single-balloon enteroscopy (SBE) as a randomized controlled trial. Hence, this study was planned to include patients having SBD with the primary aim to compare the total enteroscopy rate (TER). METHODS This study was conducted at the Asian Institute of Gastroenterology (AIG Hospitals), Hyderabad, India, from September 20, 2022, to December 15, 2022. All consecutive patients, older than 18 years with suspected SBD, and planned for total enteroscopy were screened for inclusion. The primary outcome was to compare the TER, and secondary outcomes were to compare the technical success, time taken to reach the depth of maximal insertion, withdrawal time, total procedure time, diagnostic yield, therapeutic success, and adverse events (AE). RESULTS Seventy-two patients of the 110 patients screened were randomized in either NMSE (n = 35) or SBE (n = 37) group. The most common indication for the procedures was obscure gastrointestinal bleed (48%), others being unexplained abdominal pain with indeterminate radiologic findings (32%) and chronic diarrhea (20%). In NMSE group, the TER was 71.4%, whereas in the SBE group, it was 10.8% ( P < 0.0001). The total procedure time (minutes) was much lesser with NMSE (58.17 ± 21.5 minutes) vs SBE (114.2 ± 33.5 minutes) ( P < 0.0001). The diagnostic yield of NMSE (80%) was comparatively higher than SBE (62.1%) ( P = 0.096). Minor AE (grade I) were observed in both the groups: NMSE 8.5% (3/35) and SBE 5.4% (2/37). DISCUSSION This randomized controlled trial shows that with NMSE higher TER can be achieved in shorter duration with minimal AE, compared with SBE.
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Affiliation(s)
- Hardik Rughwani
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Aniruddha Pratap Singh
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Mohan Ramchandani
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Nitin Jagtap
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Partha Pal
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Pradev Inavolu
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - P Manohar Reddy
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Wladyslaw Januszewicz
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Anuradha Sekaran
- Department of Pathology, Asian Institute of Gastroenterology Hospitals, Hyderabad, India
| | - Zaheer Nabi
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Rajendra Patel
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Rupa Banerjee
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Sana Fathima Memon
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - Putta Balram
- Department of Anaesthesiology, Asian Institute of Gastroenterology Hospitals, Hyderabad, India
| | - Santosh Darishetty
- Department of Anaesthesiology, Asian Institute of Gastroenterology Hospitals, Hyderabad, India
| | - Guduru Venkat Rao
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
| | - D Nageshwar Reddy
- Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals (AIG Hospitals), Hyderabad, India
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Pal P, Ramchandani M, Banerjee R, Viswakarma P, Singh AP, Reddy M, Rughwani H, Patel R, Sekaran A, Kanaganti S, Darisetty S, Nabi Z, Singh J, Gupta R, Lakhtakia S, Pradeep R, Venkat Rao G, Tandan M, Reddy DN. Technical performance and diagnostic yield of motorised spiral enteroscopy compared with single-balloon enteroscopy in suspected Crohn's disease: a randomised controlled, open-label study (the MOTOR-CD trial). Gut 2023; 72:1866-1874. [PMID: 37197904 DOI: 10.1136/gutjnl-2023-329885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Recent studies have shown that motorised spiral enteroscopy (MSE) enables deeper and total small bowel evaluation compared with single-balloon enteroscopy (SBE) in suspected Crohn's disease (CD) when analysed per procedure. However, no randomised controlled study has compared bidirectional MSE with bidirectional SBE in suspected CD. DESIGN Patients with suspected CD requiring small bowel enteroscopy were randomly assigned to either SBE or MSE between May 2022 and September 2022 in a high volume tertiary centre. Bidirectional enteroscopy was done if intended lesion could not be reached on unidirectional study. Comparison was made with regard to technical success (ability to reach lesion), diagnostic yield, depth of maximal insertion (DMI), procedure time and total enteroscopy rates. Depth:time ratio was calculated to avoid confounding for the location of lesion. RESULTS Among 125 suspected patients with CD (28% female, 18-65 years, median 41 years), 62 and 63 underwent MSE and SBE, respectively. The overall technical success (98.4 %: MSE, 90.5 %: SBE; p=0.11), diagnostic yield (95.2%: MSE; 87.3%: SBE, p=0.2) and procedure time were not significantly different. However, MSE appeared to have higher technical success (96.8% vs 80.7%, p=0.08) in deeper small bowel (distal jejunum/proximal ileum) with higher DMI, higher depth:time ratio and total enteroscopy rates when attempted (77.8% vs 11.1%, p=0.0007). Both the modalities were safe although minor adverse events were more common with MSE. CONCLUSION MSE and SBE have comparable technical success and diagnostic yield for small bowel evaluation in suspected CD. MSE scores over SBE with regard to deeper small bowel evaluation with complete small bowel coverage and higher depth of insertion in a shorter time. TRIAL REGISTRATION NUMBER NCT05363930.
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Affiliation(s)
- Partha Pal
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Mohan Ramchandani
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rupa Banerjee
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Piyush Viswakarma
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Manohar Reddy
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Hardik Rughwani
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rajendra Patel
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Anuradha Sekaran
- Department of Pathology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Swathi Kanaganti
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Santosh Darisetty
- Department of Aneasthesiology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Zaheer Nabi
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Jagadish Singh
- Department of Interventional Radiology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rajesh Gupta
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Sundeep Lakhtakia
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rebala Pradeep
- Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - G Venkat Rao
- Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Manu Tandan
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - D Nageshwar Reddy
- Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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Wang Y, Ma B, Li W, Li P. Effectiveness and safety of novel motorized spiral enteroscopy: a systematic review and meta-analysis. Surg Endosc 2023; 37:6998-7011. [PMID: 37349592 DOI: 10.1007/s00464-023-10179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/30/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Motorized spiral enteroscopy (MSE) is a novel advance in small bowel examination that is characterized as fast with a deep insertion. The aim of this study was to elucidate the effectiveness and safety of MSE. METHODS Relevant articles that were published before November 1, 2022 were identified by searching PubMed, EMBASE, Cochrane, and the Web of Science. The technical success rate (TSR), total (pan)-enteroscopy rate (TER), depth of maximum insertion (DMI), diagnostic yield, and adverse events were extracted and analyzed. Forest plots were graphed based on random effects models. RESULTS A total of 876 patients from 8 studies were eligible for analysis. The pooled results of the TSR were 95.0% [95% confidence interval (CI) 91.0-98.0%, I2 = 78%, p < 0.01] and the pooled outcome of the TER was 43.1% (95% CI 24.7-62.5%, I2 = 95%, p < 0.01). The pooled results of the diagnostic and therapeutic yields were 77.2% (95% CI 69.0-84.5%, I2 = 84%, p < 0.01) and 49.0% (95% CI 38.0-60.1%, I2 = 89%, p < 0.01), respectively. The pooled estimates of adverse and severe adverse events were 17.2% (95% CI 11.9-23.2%, I2 = 75%, p < 0.01) and 0.7% (95% CI 0.0-2.1%, I2 = 37%, p = 0.13), respectively. CONCLUSION MSE is a novel alternative approach for small bowel examination that can achieve high TER and diagnostic and therapeutic yields, and relatively low rates of severe adverse events. Head-to-head studies comparing MSE and other device-assisted enteroscopies are warranted.
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Affiliation(s)
- Yizi Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, 110004, China
| | - Bin Ma
- Department of Colorectal Surgery, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110042, Liaoning Province, People's Republic of China
| | - Wenya Li
- Department of Thoracic Surgery, The First Hospital of China Medical University, No.155 North Nanjing Street, Shenyang, 110001, People's Republic of China
| | - Peiwen Li
- Department of Thoracic Surgery, The First Hospital of China Medical University, No.155 North Nanjing Street, Shenyang, 110001, People's Republic of China.
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11
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Falt P, Urban O. Motorized spiral enteroscopy - a prospective analysis of 82 procedures at a single tertiary center. Scand J Gastroenterol 2023; 58:1207-1212. [PMID: 37178016 DOI: 10.1080/00365521.2023.2212311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Motorized spiral enteroscopy (MSE) is a promising novel deep enteroscopy technique. The purpose of our study was to evaluate efficiency and safety of MSE in a single tertiary endoscopy center. METHODS We prospectively evaluated all consecutive patients undergoing MSE in our endoscopy unit from June 2019 through June 2022. Main outcomes were technical success rate, proportion of procedures with sufficient depth of insertion, success rate of total enteroscopy, diagnostic yield and complication rate. RESULTS A total of 82 examinations in 62 patients (56% males, mean age 58 ± 18 years) were performed, 56 from antegrade and 26 from retrograde approach. Technical success rate was 94% (77/82) and in 89% (72/82) of cases, depth of insertion was considered sufficient. Total enteroscopy was indicated in 19 patients and it was achieved in 16 of them (84%), either by antegrade in 4 or by combined approach in 12 cases. Diagnostic yield was 81%. Lesion of the small bowel was found in 43 of patients. Mean insertion time was 40 for antegrade and 44 min for retrograde procedures, respectively. Complications occurred in 3% (2/62) of patients. One patient suffered from mild acute pancreatitis after total enteroscopy and there was one intussusception of the sigmoid during endoscope withdrawal resolved by parallel colonoscope insertion. CONCLUSION In our series of 82 procedures in 62 patients examined by MSE during a three-year period, we show high technical success rate (94%), diagnostic yield (81%) and low complication rate (3%).
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Affiliation(s)
- Přemysl Falt
- 2nd Department of Internal Medicine, University Hospital and Faculty of Medicine, Palacký University, Olomouc, Czech Republic
| | - Ondřej Urban
- 2nd Department of Internal Medicine, University Hospital and Faculty of Medicine, Palacký University, Olomouc, Czech Republic
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12
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Wei LK, Chan W, Asokkumar R. Response. Gastrointest Endosc 2023; 98:142-143. [PMID: 37331772 DOI: 10.1016/j.gie.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 06/20/2023]
Affiliation(s)
- Lim Kim Wei
- Department of Gastroenterology and Hepatology, Singapore General Hospital; Duke-NUS Graduate Medical School, Singapore
| | - Webber Chan
- Department of Gastroenterology and Hepatology, Singapore General Hospital; Duke-NUS Graduate Medical School, Singapore
| | - Ravishankar Asokkumar
- Department of Gastroenterology and Hepatology, Singapore General Hospital; Duke-NUS Graduate Medical School, Singapore
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13
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Yamamoto H, Despott EJ, González-Suárez B, Pennazio M, Mönkemüller K. The evolving role of device-assisted enteroscopy: The state of the art as of August 2023. Best Pract Res Clin Gastroenterol 2023; 64-65:101858. [PMID: 37652651 DOI: 10.1016/j.bpg.2023.101858] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
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.
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Affiliation(s)
- Hironori Yamamoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Tochigi, Japan.
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, London, UK
| | - Begoña González-Suárez
- Department of Gastroenterology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Marco Pennazio
- University Division of Gastroenterology, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Klaus Mönkemüller
- Division of Gastroenterology "Prof. Carolina Olano", Universidad de La República, Montevideo, Uruguay; Division of Endoscopy, Ameos Teaching University Hospital, Halberstadt, Germany; Department of Gastroenterology, Virginia Tech Carilion School of Medicine, Virginia, USA
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14
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Papaefthymiou A, Ramai D, Maida M, Tziatzios G, Viesca MFY, Papanikolaou I, Paraskeva K, Triantafyllou K, Repici A, Hassan C, Binda C, Beyna T, Facciorusso A, Arvanitakis M, Gkolfakis P. Performance and safety of motorized spiral enteroscopy: a systematic review and meta-analysis. Gastrointest Endosc 2023; 97:849-858.e5. [PMID: 36738795 DOI: 10.1016/j.gie.2023.01.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/11/2022] [Accepted: 01/28/2023] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS The introduction of motorized spiral enteroscopy (mSE) into clinical practice holds diagnostic and therapeutic potential for small-bowel investigations. This systematic review and meta-analysis aims to evaluate the performance of this modality in diagnosing and treating small-bowel lesions. METHODS A systematic search of MEDLINE, Cochrane, and ClinicalTrials.gov databases were performed through September 2022. The primary outcome was diagnostic success, defined as the identification of a lesion relative to the indication. Secondary outcomes were successful therapeutic manipulation, total enteroscopy rate (examination from the duodenojejunal flexion to the cecum), technical success (passage from the ligament of Treitz or ileocecal valve for anterograde and retrograde approach, respectively), and adverse event rates. We performed meta-analyses using a random-effects model, and the results are reported as percentages with 95% confidence intervals (CIs). RESULTS From 2016 to 2022, 9 studies (959 patients; 42% women; mean age >45 years; 474 patients [49.4%] investigated for mid-GI bleeding/anemia) were considered eligible and included in analysis. The diagnostic success rate of mSE was 78% (95% CI, 72-84; I2 = 78.3%). Considering secondary outcomes, total enteroscopy was attempted in 460 cases and completed with a rate of 51% (95% CI, 30-72; I2 = 96.2%), whereas therapeutic interventions were successful in 98% of cases (95% CI, 96-100; I2 = 79.8%) where attempted. Technical success rates were 96% (95% CI, 94-97; I2 = 1.5%) for anterograde and 97% (95% CI, 94-100; I2 = 38.6%) for retrograde approaches, respectively. Finally, the incidence of adverse events was 17% (95% CI, 13-21; I2 = 65.1%), albeit most were minor adverse events (16%; 95% CI, 11-20; I2 = 67.2%) versus major adverse events (1%; 95% CI, 0-1; I2 = 0%). CONCLUSIONS mSE provides high rates of diagnostic and therapeutic success with a low prevalence of severe adverse events.
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Affiliation(s)
- Apostolis Papaefthymiou
- Pancreaticobiliary Medicine Unit, University College London Hospitals (UCLH), London, UK; First Department of Pharmacology, Medical School, Aristotle University of Thessaloniki, Macedonia, Greece
| | - Daryl Ramai
- Department of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, Utah, USA
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy
| | - Georgios Tziatzios
- Department of Gastroenterology, General Hospital of Nea Ionia "Konstantopoulio-Patision," Athens, Greece
| | - Michael Fernandez Y Viesca
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, ULB, Brussels, Belgium
| | - Ioannis Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Konstantina Paraskeva
- Department of Gastroenterology, General Hospital of Nea Ionia "Konstantopoulio-Patision," Athens, Greece
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Alessandro Repici
- Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Cesare Hassan
- Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Italy
| | - Torsten Beyna
- Department of Internal Medicine, Evagelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, ULB, Brussels, Belgium
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, General Hospital of Nea Ionia "Konstantopoulio-Patision," Athens, Greece; Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, ULB, Brussels, Belgium
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15
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Pal P, Vishwakarma P, Singh AP, Reddy PM, Ramchandani M, Banerjee R, Sekaran A, Vijayalaxmi P, Rughwani H, Inavolu P, Darishetty S, Rebala P, Rao GV, Tandan M, Reddy DN. Diagnostic yield and technical performance of the novel motorized spiral enteroscopy compared with single-balloon enteroscopy in suspected Crohn's disease: a prospective study (with video). Gastrointest Endosc 2023; 97:493-506. [PMID: 36273601 DOI: 10.1016/j.gie.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/28/2022] [Accepted: 10/09/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Both single-balloon enteroscopy (SBE) and the novel motorized spiral enteroscopy (NMSE) are effective techniques for device-assisted enteroscopy (DAE). To date, no study has prospectively compared both modalities in suspected Crohn's disease (CD). METHODS Patients with suspected CD undergoing either SBE or NMSE between March 2021 and December 2021 in a high-volume tertiary center were prospectively compared for technical success (ability to reach the lesion), diagnostic yield, depth of maximal insertion (DMI), procedure time, and total enteroscopy rates. RESULTS One hundred seventy-seven patients (37.2% female; aged 7-75 years) with suspected CD underwent 201 DAEs. Technical success was 83% (SBE 81.5% vs NMSE 87.3%, P = .61) and impacted subsequent management in 92% (SBE 88.5% vs NMSE 97.8%, P = .2). Technical success with antegrade NMSE was significantly higher (81.4%) than antegrade SBE (33.3%, P = .007) for lesions in the proximal ileum and beyond. There was no significant difference in the diagnostic yield (SBE 80.8% vs NMSE 83.6%, P = .65). Median procedure time was significantly lower in both antegrade (NMSE, 40 minutes [range, 10-75]; SBE, 60 minutes [range, 20-180]; P < .0001) and retrograde (NMSE, 25 minutes [range, 20-60]; SBE, 60 minutes [range, 20-180]; P < .0001) NMSE. Median DMI was higher with antegrade NMSE (NMSE, 400 cm [range, 70-600]; SBE, 180 cm [range, 60-430]; P < .0001). The total enteroscopy rate was higher with NMSE (37% vs .7% with SBE, P < .0001). All adverse events were mild. CONCLUSIONS Both NMSE and SBE are safe and effective for small-bowel evaluation in suspected CD. NMSE is superior to SBE with regard to deeper small-bowel evaluation with complete small-bowel coverage and shorter procedure time.
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Affiliation(s)
- Partha Pal
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Piyush Vishwakarma
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Aniruddha Pratap Singh
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Palle Manohar Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Mohan Ramchandani
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rupa Banerjee
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Anuradha Sekaran
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India; Department of Pathology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Polina Vijayalaxmi
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Hardik Rughwani
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Pradev Inavolu
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Santosh Darishetty
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Pradeep Rebala
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India; Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Guduru Venkat Rao
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India; Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Manu Tandan
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - D Nageshwar Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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16
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Chan W, Wei LK, Tan T, Hsiang LG, Kong C, Salazar E, Koay D, Khor C, Asokkumar R. Motorized spiral enteroscopy versus double-balloon enteroscopy: a case-matched study. Gastrointest Endosc 2023; 97:314-324. [PMID: 36228697 DOI: 10.1016/j.gie.2022.09.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/03/2022] [Accepted: 09/23/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIMS Motorized spiral enteroscopy (MSE) has been postulated to ease the complexities of the standard-of-care double-balloon enteroscopy (DBE). However, there are no comparative studies between MSE and DBE. This study aimed to compare the therapeutic outcomes and safety between MSE and DBE. METHODS In this case-matched study, patients were matched 1:2 (MSE/DBE) by age, sex, body mass index, and American Society of Anesthesiology scores. Thirty-one patients who underwent MSE were compared with 62 patients who underwent DBE from 2014 to 2022. Our primary outcomes were to compare the technical and diagnostic success rates between DBE and MSE. Our secondary outcomes were to compare the therapeutic success and adverse event rates. RESULTS The main indications for enteroscopy were suspected GI bleeding and positive radiologic findings. Prior abdominal surgery was reported in 35.5% and 22.6% of DBE and MSE patients, respectively. Most were antegrade enteroscopy (71%). We found no significant difference in the technical success (DBE 98.4% vs MSE 96.8%, P = .62), diagnostic success (DBE 66.1% vs MSE 54.8%, P = .25), and therapeutic success rates (DBE 62.8% vs MSE 52.9%, P = .62) between the groups. Adverse events occurred in 1 DBE and 11 MSE patients. Most were minor (n = 10, 25.6%). Two patients (5.1%) in the MSE group sustained deep lacerations in the proximal esophagus requiring hospitalization. One developed ileal perforation after MSE needing surgical repair. CONCLUSIONS In patients requiring enteroscopy, the diagnostic and therapeutic performance of MSE is similar to DBE. An increased frequency of adverse events was observed with MSE. There are some restrictions in the indication because of the design of MSE.
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Affiliation(s)
- Webber Chan
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore; Division of Medicine, DUKE-NUS Graduate Medical School, Singapore
| | - Lim Kim Wei
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore; Division of Medicine, DUKE-NUS Graduate Medical School, Singapore
| | - Terence Tan
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore; Division of Medicine, DUKE-NUS Graduate Medical School, Singapore
| | - Lim Gek Hsiang
- Health Services Research Unit, Singapore General Hospital, Singapore
| | - Christopher Kong
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore; Division of Medicine, DUKE-NUS Graduate Medical School, Singapore
| | - Ennaliza Salazar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore; Division of Medicine, DUKE-NUS Graduate Medical School, Singapore
| | - Doreen Koay
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Christopher Khor
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore; Division of Medicine, DUKE-NUS Graduate Medical School, Singapore
| | - Ravishankar Asokkumar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore; Division of Medicine, DUKE-NUS Graduate Medical School, Singapore
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17
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Pennazio M, Rondonotti E, Despott EJ, Dray X, Keuchel M, Moreels T, Sanders DS, Spada C, Carretero C, Cortegoso Valdivia P, Elli L, Fuccio L, Gonzalez Suarez B, Koulaouzidis A, Kunovsky L, McNamara D, Neumann H, Perez-Cuadrado-Martinez E, Perez-Cuadrado-Robles E, Piccirelli S, Rosa B, Saurin JC, Sidhu R, Tacheci I, Vlachou E, Triantafyllou K. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2022. Endoscopy 2023; 55:58-95. [PMID: 36423618 DOI: 10.1055/a-1973-3796] [Citation(s) in RCA: 68] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
MR1: ESGE recommends small-bowel capsule endoscopy as the first-line examination, before consideration of other endoscopic and radiological diagnostic tests for suspected small-bowel bleeding, given the excellent safety profile of capsule endoscopy, its patient tolerability, and its potential to visualize the entire small-bowel mucosa.Strong recommendation, moderate quality evidence. MR2: ESGE recommends small-bowel capsule endoscopy in patients with overt suspected small-bowel bleeding as soon as possible after the bleeding episode, ideally within 48 hours, to maximize the diagnostic and subsequent therapeutic yield.Strong recommendation, high quality evidence. MR3: ESGE does not recommend routine second-look endoscopy prior to small-bowel capsule endoscopy in patients with suspected small-bowel bleeding or iron-deficiency anemia.Strong recommendation, low quality evidence. MR4: ESGE recommends conservative management in those patients with suspected small-bowel bleeding and high quality negative small-bowel capsule endoscopy.Strong recommendation, moderate quality evidence. MR5: ESGE recommends device-assisted enteroscopy to confirm and possibly treat lesions identified by small-bowel capsule endoscopy.Strong recommendation, high quality evidence. MR6: ESGE recommends the performance of small-bowel capsule endoscopy as a first-line examination in patients with iron-deficiency anemia when small bowel evaluation is indicated.Strong recommendation, high quality evidence. MR7: ESGE recommends small-bowel capsule endoscopy in patients with suspected Crohn's disease and negative ileocolonoscopy findings as the initial diagnostic modality for investigating the small bowel, in the absence of obstructive symptoms or known bowel stenosis.Strong recommendation, high quality evidence. MR8: ESGE recommends, in patients with unremarkable or nondiagnostic findings from dedicated small-bowel cross-sectional imaging, small-bowel capsule endoscopy as a subsequent investigation if deemed likely to influence patient management.Strong recommendation, low quality evidence. MR9: ESGE recommends, in patients with established Crohn's disease, the use of a patency capsule before small-bowel capsule endoscopy to decrease the capsule retention rate.Strong recommendation, moderate quality evidence. MR10: ESGE recommends device-assisted enteroscopy (DAE) as an alternative to surgery for foreign bodies retained in the small bowel requiring retrieval in patients without acute intestinal obstruction.Strong recommendation, moderate quality evidence. MR11: ESGE recommends DAE-endoscopic retrograde cholangiopancreatography (DAE-ERCP) as a first-line endoscopic approach to treat pancreaticobiliary diseases in patients with surgically altered anatomy (except for Billroth II patients).Strong recommendation, moderate quality evidence.
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Affiliation(s)
- Marco Pennazio
- University Division of Gastroenterology, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | | | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, London, UK
| | - Xavier Dray
- Sorbonne University, Endoscopy Unit, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - Martin Keuchel
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany
| | - Tom Moreels
- Division of Gastroenterology and Hepatology, University Hospital Saint-Luc, Brussels, Belgium
| | - David S Sanders
- Sheffield Teaching Hospitals NHS Foundation Trust, Gastroenterology Sheffield, Sheffield, UK
| | - Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina Carretero
- Department of Gastroenterology. University of Navarre Clinic, Healthcare Research Institute of Navarre, Pamplona, Spain
| | - Pablo Cortegoso Valdivia
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Fuccio
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna, Bologna, Italy
| | - Begona Gonzalez Suarez
- Gastroenterology Department - ICMDiM, Hospital Clínic of Barcelona, DIBAPS, CiBERHED, Barcelona, Spain
| | - Anastasios Koulaouzidis
- Centre for Clinical Implementation of Capsule Endoscopy, Store Adenomer Tidlige Cancere Center, Svendborg, University of Southern Denmark, Denmark
| | - Lumir Kunovsky
- 2nd Department of Internal Medicine - Gastroenterology and Geriatrics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic.,Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Deirdre McNamara
- TAGG Research Centre, Department of Clinical Medicine, Trinity Centre, Tallaght Hospital, Dublin, Ireland
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany
| | | | | | - Stefania Piccirelli
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
| | - Bruno Rosa
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga/Guimarães, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Jean-Christophe Saurin
- Gastroenterology and Endoscopy Unit, Hospices Civils de Lyon, Hôpital E. Herriot, Lyon, France
| | - Reena Sidhu
- Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals, Sheffield, United Kingdom.,Department of Infection, Immunity and Cardiovascular Diseases, University of Sheffield, United Kingdom
| | - Ilja Tacheci
- 2nd Department of Internal Medicine - Gastroenterology, University Hospital Hradec Králové, Charles University, Faculty of Medicine in Hradec Králové, Czech Republic
| | | | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
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18
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Beyna T, Moreels T, Arvanitakis M, Pioche M, Saurin JC, May A, Knabe M, Agnholt JS, Bjerregaard NC, Puustinen L, Schlag C, Aabakken L, Paulsen V, Schneider M, Neurath MF, Rath T, Devière J, Neuhaus H. Motorized spiral enteroscopy: results of an international multicenter prospective observational clinical study in patients with normal and altered gastrointestinal anatomy. Endoscopy 2022; 54:1147-1155. [PMID: 35451040 DOI: 10.1055/a-1831-6215] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND : Motorized spiral enteroscopy (MSE) has been shown to be safe and effective for deep enteroscopy in studies performed at expert centers with limited numbers of patients without previous abdominal surgery. This study aimed to investigate the safety, efficacy, and learning curve associated with MSE in a real-life scenario, with the inclusion of patients after abdominal surgery and with altered anatomy. METHODS : Patients with indications for deep enteroscopy were enrolled in a prospective observational multicenter study. The primary objective was the serious adverse event (SAE) rate; secondary objectives were the diagnostic and therapeutic yield, procedural success, time, and insertion depth. Data analysis was subdivided into training and core (post-training) study phases at centers with different levels of MSE experience. RESULTS : 298 patients (120 women; median age 68, range 19-92) were enrolled. In the post-training phase, 21.5 % (n = 54) had previous abdominal surgery, 10.0 % (n = 25) had surgically altered anatomy. Overall, SAEs occurred in 2.3 % (7/298; 95 %CI 0.9 %-4.8 %). The SAE rate was 2.0 % (5/251) in the core group and 4.3 % (2/47) in the training group, and was not increased after abdominal surgery (1.9 %). Total enteroscopy was achieved in half of the patients (n = 42) undergoing planned total enteroscopy. In 295/337 procedures (87.5 %), the anatomical region of interest could be reached. CONCLUSIONS : This prospective multicenter study showed that MSE was feasible and safe in a large cohort of patients in a real-life setting, after a short learning curve. MSE was shown to be feasible in postsurgical patients, including those with altered anatomy, without an increase in the SAE rate.
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Affiliation(s)
- Torsten Beyna
- Department of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Germany
| | - Tom Moreels
- Department of Gastroenterology and Hepatology, Hospital Department Clinique Universitaires Saint-Luc Université, Brussels, Belgium
| | - Marianna Arvanitakis
- Department of Gastroenterology and Hepato-Pancreatology, Université Libre des Bruxelles, Erasme Hospital, Brussels, Belgium
| | - Mathieu Pioche
- Department of Digestive Diseases, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Jean-Christophe Saurin
- Department of Digestive Diseases, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Andrea May
- Department of Internal Medicine II, Sana Klinikum Offenbach GmbH, Offenbach, Germany.,Department of Gastroenterology, Asklepios Paulinen Klinik, Wiesbaden, Germany
| | - Mate Knabe
- Department of Internal Medicine II, Sana Klinikum Offenbach GmbH, Offenbach, Germany.,Department of Gastroenterology and Hepatology, Center of Internal Medicine, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jørgen Steen Agnholt
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lauri Puustinen
- Division of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland
| | - Christoph Schlag
- Department of Internal Medicine II, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.,Department of Gastroenterology and Endoscopy, Universitätsspital Zürich, Zurich, Switzerland
| | - Lars Aabakken
- Institute of Clinical Medicine, OUS-Rikshospitalet University Hospital, Oslo, Norway
| | - Vemund Paulsen
- Institute of Clinical Medicine, OUS-Rikshospitalet University Hospital, Oslo, Norway
| | - Markus Schneider
- Department of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Germany
| | - Markus F Neurath
- Department of Internal Medicine I for Gastroenterology, Pulmonology and Endocrinology, University Hospital Erlangen, Erlangen, Germany
| | - Timo Rath
- Department of Internal Medicine I for Gastroenterology, Pulmonology and Endocrinology, University Hospital Erlangen, Erlangen, Germany
| | - Jacques Devière
- Department of Gastroenterology and Hepato-Pancreatology, Université Libre des Bruxelles, Erasme Hospital, Brussels, Belgium
| | - Horst Neuhaus
- Department of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Germany
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19
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Affiliation(s)
- Marco Pennazio
- University Division of Gastroenterology, City of Health and Science University Hospital, Turin, Italy
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20
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Luna-Rodriguez D, Maisterra S, Garcia-Sumalla A, Puigcerver-Mas M, Gornals JB. Endoscopic ultrasound-guided antegrade stenting for benign biliary disease in an elderly patient with altered anatomy (Roux-en-Y). Endoscopy 2022; 55:E165-E166. [PMID: 36307079 PMCID: PMC9829821 DOI: 10.1055/a-1960-2756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Daniel Luna-Rodriguez
- Endoscopy Unit, Digestive Diseases Department, Hospital Universitari de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain,University of Barcelona, Barcelona, Spain
| | - Sandra Maisterra
- Endoscopy Unit, Digestive Diseases Department, Hospital Universitari de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain,University of Barcelona, Barcelona, Spain
| | - Albert Garcia-Sumalla
- Endoscopy Unit, Digestive Diseases Department, Hospital Universitari de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain,University of Barcelona, Barcelona, Spain
| | - Maria Puigcerver-Mas
- Endoscopy Unit, Digestive Diseases Department, Hospital Universitari de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain,University of Barcelona, Barcelona, Spain
| | - Joan B. Gornals
- Endoscopy Unit, Digestive Diseases Department, Hospital Universitari de Bellvitge-IDIBELL, University of Barcelona, Barcelona, Spain,University of Barcelona, Barcelona, Spain,Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
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21
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Giordano A, Casanova G, Escapa M, Fernández-Esparrach G, Ginès À, Sendino O, Araujo IK, Cárdenas A, Córdova H, Martínez-Ocon J, Martínez-Palli G, Balaguer F, Llach J, Ricart E, González-Suárez B. Motorized Spiral Enteroscopy Is Effective in Patients with Prior Abdominal Surgery. Dig Dis Sci 2022; 68:1447-1454. [PMID: 36104534 PMCID: PMC10102144 DOI: 10.1007/s10620-022-07688-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/31/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Motorized Spiral Enteroscopy (MSE) reduces procedure time and increases insertion depth into the small bowel; however, there is scarce evidence on factors affecting MSE efficacy. AIMS To evaluate diagnostic yield and adverse events of MSE including patients with prior major abdominal surgery. METHODS A prospective observational study was conducted on patients undergoing MSE from June 2019 to December 2021. Demographic characteristics, procedure time, depth of maximum insertion (DMI), technical success, diagnostic yield, and adverse events were collected. RESULTS Seventy-four anterograde (54.4%) and 62 retrograde (45.6%) enteroscopies were performed in 117 patients (64 males, median age 67 years). Fifty patients (42.7%) had prior major abdominal surgery. Technical success was 91.9% for anterograde and 90.3% for retrograde route. Diagnostic yield was 71.6% and 61.3%, respectively. The median DMI was 415 cm (264-585) for anterograde and 120 cm (37-225) for retrograde enteroscopy. In patients with prior major abdominal surgery, MSE showed significantly longer small bowel insertion time (38 vs 29 min, p = 0.004), with similar diagnostic yield (61 vs 71.4%, p = 0.201) and DMI (315 vs 204 cm, p = 0.226). The overall adverse event rate was 10.3% (SAE 1.5%), with no differences related to prior abdominal surgery (p = 0.598). Patients with prior surgeries directly involving the gastrointestinal tract showed lower DMI (189 vs 374 cm, p = 0.019) with equal exploration time (37.5 vs 38 min, p = 0.642) compared to those with other abdominal surgeries. CONCLUSIONS MSE is effective and safe in patients with major abdominal surgery, although longer procedure times were observed. A lower depth of insertion was detected in patients with gastrointestinal surgery.
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Affiliation(s)
- Antonio Giordano
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gherzon Casanova
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Miriam Escapa
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Àngels Ginès
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Oriol Sendino
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Isis K Araujo
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Andrés Cárdenas
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain.,GI & Liver Transplant Unit, Institut de Malalties Digestives i Metaboliques, Hospital Clinic, Barcelona, Spain
| | - Henry Córdova
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | | | - Graciela Martínez-Palli
- Faculty of Medicine, University of Barcelona, Barcelona, Spain.,Anesthesiology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Francesc Balaguer
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Josep Llach
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Elena Ricart
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Begoña González-Suárez
- Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain. .,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain. .,Faculty of Medicine, University of Barcelona, Barcelona, Spain.
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22
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Al-Toma A, Oude Hergelink DM, Tenthof van Noorden J, Koornstra JJ. Prospective evaluation of the motorized spiral enteroscope for previous incomplete colonoscopy. Endosc Int Open 2022; 10:E1112-E1117. [PMID: 36238532 PMCID: PMC9552671 DOI: 10.1055/a-1869-2541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background and study aims A significant percentage of colonoscopies remain incomplete because of failure to intubate the cecum. The motorized spiral enteroscope (MSE) technique, originally developed for deep small bowel enteroscopy, may be an effective alternative technique in cases of incomplete examination of abnormally long colons (dolichocolon). We prospectively evaluated the success rate of cecal intubation, safety and the therapeutic consequences of using MSE after incomplete conventional colonoscopy. Patients and methods A total of 36 consecutive patients with an indication for diagnostic and/or therapeutic colonoscopy were prospectively enrolled in this multicenter trial. All patients had undergone at least one incomplete colonoscopy attributed to abnormally long colons. Patients with incomplete colonoscopy due to stenosis were excluded. Results Twenty-two men and 14 women (median age 66 years, range 35-82) were enrolled. Median procedure time was 30 minutes (range 16-50). Cecal intubation rate was 100 % and median cecal intubation time was 10 minutes (range 4-30). Abnormalities, mostly neoplastic lesions, were detected in 23 of 36 patients, corresponding to a diagnostic yield of 64 %. All these findings were in the right side of the colon and had not been described by the antecedent incomplete coloscopy. No adverse events occurred. Conclusions In case of a difficult and long colon, MSE is safe and effective for diagnostic and therapeutic colonoscopy. It may provide an attractive solution to accomplish completeness of previous incomplete colonoscopies in these patients.
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Affiliation(s)
- Abdulbaqi Al-Toma
- Department of Gastroenterology and hepatology, St. Antonius hospital, Nieuwegein, the Netherlands
| | - Dorien M. Oude Hergelink
- Department of Gastroenterology & Hepatology, University Medical Centre Groningen, University of Groningen, The Netherlands
| | | | - Jan Jacob Koornstra
- Department of Gastroenterology & Hepatology, University Medical Centre Groningen, University of Groningen, The Netherlands
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23
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Alemanni LV, Fabbri S, Rondonotti E, Mussetto A. Recent developments in small bowel endoscopy: the "black box" is now open! Clin Endosc 2022; 55:473-479. [PMID: 35831981 PMCID: PMC9329645 DOI: 10.5946/ce.2022.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/11/2022] [Indexed: 12/09/2022] Open
Abstract
Over the last few years, capsule endoscopy has been established as a fundamental device in the practicing gastroenterologist’s toolbox. Its utilization in diagnostic algorithms for suspected small bowel bleeding, Crohn’s disease, and small bowel tumors has been approved by several guidelines. The advent of double-balloon enteroscopy has significantly increased the therapeutic possibilities and release of multiple devices (single-balloon enteroscopy and spiral enteroscopy) aimed at improving the performance of small bowel enteroscopy. Recently, some important innovations have appeared in the small bowel endoscopy scene, providing further improvement to its evolution. Artificial intelligence in capsule endoscopy should increase diagnostic accuracy and reading efficiency, and the introduction of motorized spiral enteroscopy into clinical practice could also improve the therapeutic yield. This review focuses on the most recent studies on artificial-intelligence-assisted capsule endoscopy and motorized spiral enteroscopy.
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Affiliation(s)
- Luigina Vanessa Alemanni
- Gastroenterology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy.,Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Stefano Fabbri
- Gastroenterology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy.,Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
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