Motorized spiral enteroscopy versus double-balloon enteroscopy: a case-matched study

Chan, Webber; Wei, Lim Kim; Tan, Terence; Hsiang, Lim Gek; Kong, Christopher; Salazaar, Ennaliza; Koay, Doreen Siew Ching; Khor, Christopher; Asokkumar, Ravishankar

doi:10.1016/j.gie.2022.09.030

Cited by 22 publications

(30 citation statements)

References 23 publications

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“…This is the first randomised controlled study comparing two modalities of enteroscopy (MSE and SBE) in suspected small bowel CD. Earlier comparative studies between MSE and SBE analysed technical success of both these modalities considering the factors per procedure (antegrade and retrograde considered separate procedures) 13 14. However, the true efficacy of these modalities should be compared in a bidirectional approach given that retrograde MSE was technically feasible in all attempted cases in the current study compared with earlier manual SE reports focussing only on the antegrade approach 23.…”

Section: Discussionmentioning

confidence: 88%

“…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. 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.…”

Section: Introductionmentioning

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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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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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“…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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“…Our previous retrospective study (9) and multiple recently published prospective studies (10)(11)(12)(13)(14)(15)(16) have shown that NMSE has a high diagnostic yield with a high TER in a short procedure time.…”

Section: Introductionmentioning

confidence: 94%

A Randomized, Controlled Trial Comparing the Total Enteroscopy Rate and Diagnostic Efficacy of Novel Motorized Spiral Enteroscopy and Single-Balloon Enteroscopy in Patients With Small-Bowel Disorders: The Motor Trial (NCT 05548140)

Rughwani,

Singh,

Ramchandani

et al. 2023

Am J Gastroenterol

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Introduction: Device-assisted enteroscopy (DAE) has revolutionized the management of Small Bowel Disorders (SBD). No study to date has compared both Novel Motorized Spiral Enteroscopy (NMSE) and Single Balloon Enteroscopy (SBE) as a randomized controlled trial. Hence, this study was planned to include patients having SBD with the primary aim to compare the Total Enteroscopy Rate (TER). Methods: This study was conducted at the Asian Institute of Gastroenterology (AIG Hospitals), Hyderabad, India from 20th September 2022 to 15th December 2022. All consecutive patients, aged more than 18 years with suspected SBD, and planned for Total Enteroscopy (TE) were screened for inclusion. The primary outcome was to compare the TER and secondary outcomes were to compare the technical success, time taken to reach the Depth of Maximal Insertion (DMI), withdrawal time, total procedure time, diagnostic yield, therapeutic success, and adverse events. Results: Seventy-two patients out of the 110 patients screened, were randomized in either of NMSE (n=35) or SBE (n=37) group. The most common indication for the procedures was obscure GI bleed (48%), others being unexplained abdominal pain with indeterminate radiologic findings (32%) and chronic diarrhea (20%). In NMSE group the TER was 71.4%; while in the SBE group, it was 10.8%, (p<0.0001). The total procedure time (min) was much lesser with NMSE (58.17±21.5 min) versus SBE (114.2±33.5 min), (p<0.0001). The diagnostic yield of NMSE (80%) was comparatively higher than SBE (62.1%), (p = 0.096). Minor adverse events (Grade I) were observed in both the groups: NMSE (3/35, 8.5%) and SBE (2/37, 5.4%). Conclusion: This RCT shows that with NMSE higher TER can be achieved in shorter duration with minimal adverse events, compared to SBE.

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Motorized spiral enteroscopy versus double-balloon enteroscopy: a case-matched study

Cited by 22 publications

References 23 publications

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)

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)

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

A Randomized, Controlled Trial Comparing the Total Enteroscopy Rate and Diagnostic Efficacy of Novel Motorized Spiral Enteroscopy and Single-Balloon Enteroscopy in Patients With Small-Bowel Disorders: The Motor Trial (NCT 05548140)

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