Post written by Ravishankar Asokkumar, MBBS, FRCP, FASGE, from the Department of Gastroenterology and Hepatology, Singapore General Hospital, and the Division of Medicine, DUKE-NUS Graduate Medical School, Singapore.

Evaluation of the small intestine can be tedious and challenging because of its anatomical nature. For a long time, double-balloon enteroscopy (DBE) has been considered the gold standard for examining small-bowel pathologies.

However, DBE can be complex, technically demanding, and time-consuming. Recently, the novel motorized spiral enteroscopy (MSE) was developed to ease the complexity of enteroscopy procedures.

The findings of early reports on the feasibility and utility of MSE to identify and treat small-bowel pathologies have been promising, with a high diagnostic and technical success rate. In addition, the time required to perform the enteroscopy exam has been shown to be shorter.

Nonetheless, no comparative studies are available to understand the performance of MSE and DBE. We aimed to compare the diagnostic yield, therapeutic success, and adverse event rates between MSE and DBE in a propensity-matched cohort of patients who required small-bowel evaluation.

We compared 62 DBE and 31 MSE patients matched by age, sex, body mass index, and American Society of Anesthesiology score. The main indication for enteroscopy was GI bleeding and abnormal radiological findings.

In total, 35.5% of DBE patients and 22.6% of MSE patients reported prior surgery. The majority (71%) of the procedures were antegrade enteroscopy.

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. The total enteroscopy rate by antegrade MSE was 14.3% and none in the DBE group. There was no significant difference in the total procedure time.

The majority of the adverse events with DBE and MSE were minor. Esophageal injuries were common in the MSE group, as reported in previous studies. Two patients in the MSE group sustained deep lacerations in the proximal esophagus requiring hospitalization. One developed ileal perforation needing surgical repair.

In conclusion, MSE represents significant progress compared with the previous spiral enteroscopy. In our study, we found the diagnostic and therapeutic performance of MSE is similar to that of DBE.

Our extensive experience with DBE could have impacted the results. The design of MSE might restrict its application in specific indications to limit the occurrence of adverse events. Extensive prospective comparative studies, including those involving nonexpert centers, are needed to understand the effectiveness of both devices.

Motorized spiral enteroscopy and its parts. A, Enteroscope with the integrated electric motor. B, Distal overtube with spiral-shaped fins. C, Foot switch to activate the spiral overtube rotation. D, Visual force gauge to display the torque applied to the small bowel.

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