Post written by Mohan Ramchandani, MD, DM, from the Department of Gastroenterology, Asian Institute of Gastroenterology Hospitals, Hyderabad, India.
The small bowel is long mobile organ in the peritoneum, which makes it difficult to be evaluated by conventional endoscopy. Deep enteroscopy (DE) is a cumbersome procedure; there are many shortcomings of balloon-assisted enteroscopy (BAE), which is presently regarded as the “gold standard” for assessment and treatment of small-bowel disorders. Motorized spiral enteroscopy is the new kid on the block for DE, and this study was a retrospective analysis to assess its diagnostic yield and therapeutic impact in small-bowel disorders.
There are limited data available on the utility of novel motorized spiral enteroscopy (NMSE) in real-world clinical scenarios, and it is important to assess the pros and cons of this new system. Balloon-assisted enteroscopy has brought a paradigm shift in the management of small-bowel disorders; however, there are many pitfalls. BAE is a lengthy procedure and cumbersome to do. Moreover, longer scope (200 cm), narrower therapeutic channel (2.8 mm), and absence of accessory water channel makes it less attractive as far as therapeutic procedures are concerned. NMSE is designed to overcome all these issues. The scope is self-propelled, assisted by a motor that makes the procedure less labor intensive for the operator. The scope provides a more stable platform and is less likely to slip back as the spiral overtube grips the small bowel better than a balloon. The enteroscope is ideal for therapeutic enteroscopy as the scope is only 168 cm long, and all routinely available accessories can be used. Moreover, there is a wider therapeutic channel of 3.2 mm, and there is an accessory water channel.
In this study, 61 patients with suspected small-bowel disorders underwent NMSE. NMSE provided a high diagnostic yield (65%), a higher panenteroscopy rate (60%), and could provide stable enteroscope position to perform therapeutic procedures. The drawback of this procedure is that patients require general anaesthesia and intubation for antegrade procedures. In absence of tactile feedback to operator, one has to be extremely careful in performing this procedure in patients who are likely to have adhesions, especially postoperative patients. Moreover, it is contraindicated in patients with large oesophageal varices, diseases with poor oesophageal compliance like eosinophilic esophagitis, and paediatric patients, especially infants and toddlers.
Our study suggests that NMSE takes less time for the procedure and achieves total enteroscopy with minimal adverse events, making it an extremely exciting prospect for the future in the field of enteroscopy and in planning future comparative studies. Randomized controlled trials should be done in the future for head-to-head comparison of NMSE and BAE.
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