Post written by Mohan Ramchandani, MD, DM, from the Department of Medical Gastroenterology, AIG Hospitals, Hyderabad, Telangana, India.
We describe a case of young man with history of chronic kidney disease on maintenance hemodialysis. He underwent capsule endoscopy (CE) 6 months ago for evaluation of obscure occult gastrointestinal bleeding requiring multiple transfusions. CE revealed ileal stricture, but unfortunately CE couldn’t progress beyond stricture and was retained. He was not symptomatic for obstruction and was not willing to undergo surgery. He underwent novel motorized spiral enteroscopy (NMSE)-assisted removal of CE. NMSE was done under GA, the enteroscope was advance up to distal small bowel. Ulcerated stricture was identified, intraprocedural contrast study revealed multiple strictures. Strictures were dilated with ‘through the scope’ balloon dilator, and capsule was subsequently retrieved. The patient had uneventful recovery and was managed medically for the Crohn’s disease.
Small bowel disorders (SBD) are a diagnostic and therapeutic challenge for a treating physician. The technique of deep enteroscopy is evolving, and we are still looking for ideal enteroscope, which enables us to do pan enteroscopy in reasonably quick time. Balloon-assisted enteroscopy (BAE) brought a paradigm shift in management of SBD, but the problem with BAE is that it’s cumbersome and time consuming. Novel motorized spiral enteroscopy is the new kid on the block for deep enteroscopy. The major advantage of this new technique is self-propulsion, which makes the procedure less labor intensive. The shorter length of enteroscope (168 cm) enables us to use routinely available accessories for therapeutic purposes. The 3.2 instrument channel diameter and availability of water jet makes the therapeutic enteroscopy much easier. The stability of enteroscopy is very important especially when you are doing therapeutic procedures in the deep intestine, and NMSE provides a stable platform as there is less slippage because of spiral overtube. The disadvantage of NMSE is that it requires general anesthesia and endotracheal intubation for antegrade approach, and there is no tactile feedback to the operator while performing enteroscopy. We describe a case of retained capsule endoscope in a patient with Crohn’s disease, which was successfully removed using this novel device. CE is an important modality for th evaluation of SBD, but the possibility of CE retention exists and may occur in 5-13% of patients with suspected Crohn’s disease. Retained capsule can either be removed by surgery or by enteroscopy. The advantage of surgery is that it allows removal of both the capsule and the pathology that caused the capsule retention, while enteroscopic removal is less invasive and allows stricture dilatation and tissue acquisition for histopathological assessment.
NMSE can be considered as an effective alternative in diagnostic and therapeutic enteroscopy. Small bowel pathologies including simple strictures dilatation and retained capsule can be managed by this new device. NMSE enables us do to deep enteroscopy in a reasonably quick time and has added advantages of shorter scope with larger therapeutic channel. Further studies are required to assess the efficacy of this novel device in managing SBD.
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