Motorized spiral enteroscopy-assisted ERCP in surgically altered anatomy: early experience from a retrospective cohort study

Abstract

BACKGROUND & STUDY AIMS: Motorized Spiral enteroscopy (MSE) was recently introduced into clinical practice. The aim of the current study was the evaluation of feasibility and safety of MSE for biliopancreatic interventions in patients with surgically altered anatomy. PATIENTS & METHODS: Patients with surgically altered anatomy receiving MSE-assisted ERCP at a single endoscopic reference center were retrospectively enrolled between January 2016 and June 2021. RESULTS: 36 patients (14 female, 22 male), median age 67 years (range 43-88) and biliary (n=35) and pancreatic (n=1) indications for MSE-ERCP were enrolled. The majority (75%) had relevant comorbidities (ASA III). Types of surgical reconstruction: Roux-en-Y n=30, Billroth II n=6. Technical success rates for enteroscopy, cannulation and interventions were 86.1%, 83.9% and 100%, respectively. Overall MSE-ERCP-success rate was 72.2%. One major complication occurred (2.8%; delayed post-sphincterotomy bleeding). CONCLUSIONS: The current study showed for the first-time feasibility and safety of MSE-assisted ERCP in postsurgical patients with altered anatomy at an expert center. This data justifies further evaluation of this new technique preferably in a prospective multicenter trial. Clinicaltrials.gov: NCT04912440

Motorized spiral enteroscopy: effectiveness when used for new indications

“…On the other hand, motorized spiral enteroscopy was less efficient in reaching the excluded stomach in RYGB patients as compared to balloon-assisted enteroscopy (9). Finally, although (biliary) ERCP using the PSF-1 is feasible in patients with surgically altered anatomy with a technical success rate of 76% in the current study, these results suggest a lower technical success rate as compared to enteroscopy-assisted ERCP using balloon-assisted enteroscopy techniques (15,16). The lower technical success rates to reach the excluded stomach in RYGB patients and to perform ERCP in patient with surgically altered anatomy, is most likely related to the fact that the PSF-1 is a colonoscope loaded with a motorized spiral overtube.…”

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

“…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.…”

“…Its first clinical use was presented in 2016, and ever since, it has proved its efficacy and safety for diagnostic and therapeutic procedures in first observational studies [1,2]. At present, more and more endoscopic facilities are introducing MSE, and the amount of published literature on this subject is rapidly increasing [3,4].…”

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)

“…Requirement of GA for antegrade MSE, need for hospitalisation, total overall time due to need for intubation and recovery, lack of tactile feedback (specially in postoperative settings), technical difficulty in low body mass index (BMI)/paediatric patients (large scope calibre) and need for additional training (although learning curve relatively small, nearly 5 for training and 20 for additional experience) are few drawbacks of MSE 23 28–30. The overall procedure time could actually be longer with MSE compared with SBE due to GA induction and recovery time.…”

“…We also did not compare the MSE with DBE although DBE and SBE have been shown to be comparable in all aspects as per systematic review and meta-analysis 34. We did not include paediatric or postoperative patients in which SBE could be advantageous 13 30…”