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)

Pal, Partha; Vishwakarma, P.K.; Singh, Aniruddha Pratap; Reddy, Palle Manohar; Ramchandani, Mohan; Banerjee, Rupa; Sekaran, Anuradha; Vijayalaxmi, Polina; Rughwani, Hardik; Inavolu, Pradev; Darishetty, Santosh; Rebala, Pradeep; Rao, Guduru Venkat; Tandan, Manu; Reddy, D. Nageshwar

doi:10.1016/j.gie.2022.10.017

Cited by 13 publications

(40 citation statements)

References 23 publications

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“…Owing to the novelty of MSE, data on its safety are still relatively scarce [5,6]. To our knowledge, to this date, the safety evidence is based on approximately 1190 patients from 14 studies [1,3,7,8,9,10,11,12,13,14,15,16,17,18]. Large studies like the currently ongoing prospective multicentric "GPS-Registry" under the guidance of Professor Allgaier and Dr. Steinbrück (Freiburg, Germany) will help to further expand data on its performance in the true clinical setting.…”

Section: Discussion and Review Of The Literaturementioning

confidence: 99%

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

Wiedbrauck

Freund

et al. 2023

Z Gastroenterol

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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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Section: Discussion and Review Of The Literaturementioning

confidence: 99%

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

Wiedbrauck

Freund

et al. 2023

Z Gastroenterol

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“…MSE had higher diagnostic yield (65%), greater depth of insertion and higher total enteroscopy rates in an earlier retrospective study although the diagnostic yield in inflammatory lesions (41%) was not separately reported 12. A recent prospective, non-randomised study has shown that MSE and SBE have comparable technical success and diagnostic yield in suspected isolated small bowel CD when analysed per-procedure with the MSE group exhibiting a significantly higher depth of insertion in a shorter time 13. Another recent case-matched study comparing DBE with MSE (DBE: MSE=2:1), which included suspected CD, showed comparable technical success and diagnostic yield 14.…”

Section: Introductionmentioning

confidence: 86%

“…Patients who underwent only retrograde MSE received deep sedation with propofol. SBE (XSIF-Q260Y; Olympus Medical Systems, Tokyo, Japan) was done under monitored anaesthesia (deep sedation with propofol) 13. The route of enteroscopy was based on location on prior CTE/MRE or VCE 15.…”

Section: Methodsmentioning

confidence: 99%

“…All cross-sectional imaging was discussed with an expert GI radiologist (JS) and small bowel was traced from duodena-jejunal flexure (DJ) or ileocecal junction (ICJ) to determine the location of the anatomic region of interest and distance from DJ/ICJ. JS manually measured the distance from DJ flexure or IC valve by tracing and measuring loops of intestine from DJ flexure/IC junction based on whichever was closer to the lesion and finally added them to get estimated distance from DJ/IC valve 13. Small bowel was divided into three parts: upper small bowel (proximal and mid-jejunum), mid or deep small bowel (distal jejunum to proximal ileum) and lower small bowel (mid and distal ileum) for the purpose of analysing outcomes region wise.…”

Section: Methodsmentioning

confidence: 99%

“…Another recent case-matched study comparing DBE with MSE (DBE: MSE=2:1), which included suspected CD, showed comparable technical success and diagnostic yield 14. However, the true technical efficacy of these two principles of enteroscopy needs to be compared by bidirectional approach in contrast to the aforementioned studies 13 14. Given the advent of MSE, the preferred mode of enteroscopy for investigation of suspected small bowel CD is not known.…”

Section: Introductionmentioning

confidence: 99%

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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)

Pal

Ramchandani

Banerjee

et al. 2023

Gut

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ObjectiveRecent 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.DesignPatients 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.ResultsAmong 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.ConclusionMSE 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 numberNCT05363930.

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„Das Ende der Motor-Spirale“ - ein Nachruf

Hollerbach

2023

Gastro-News

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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)

Cited by 13 publications

References 23 publications

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

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

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)

„Das Ende der Motor-Spirale“ - ein Nachruf

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