The performance and safety of motorized spiral enteroscopy, including in patients with surgically altered gastrointestinal anatomy: a multicenter prospective study

Abstract

BACKGROUND AND STUDY AIMS: Data are scarce on the efficacy and safety of the Motorized spiral enteroscopy (MSE). No data are available on the utility of this technique in patients with surgically-altered gastrointestinal (GI) anatomy. We aimed to evaluate the safety and efficacy of MSE in patients with suspected small-bowel disease including those with surgically-altered GI anatomy. METHODS: A multicenter prospective observational, uncontrolled study evaluated MSE in consecutive patients with suspected small-bowel pathology indicated for diagnostic and/or therapeutic intervention. RESULTS: A total of 170 patients (median age, 64 years; range 18-89 years; 102 male, 68 female) were included. The overall diagnostic yield was 64.1%. Endotherapy was performed in 53.5% of procedures. The median total procedure time for antegrade and retrograde approach was 45 minutes (IQR=30-80) and 40 (IQR=30-70) respectively. When total (pan-)enteroscopy was intended, this was achieved at rate of 70.3%, (28.1% by antegrade approach and 42.1% by a bi-directional approach). Surgically-altered GI anatomy was present in 34/170 (20%) of the all procedures and in 11/45 (24.4%) of the successful total enteroscopy procedures. Propofol sedation or general anesthesia were used in 92.9% and 7% of the procedures respectively. Minor adverse events were observed in 15.8% of patients, but no major adverse events. CONCLUSION: MSE seems to be effective and safe endoscopic procedure. Total (pan-)enteroscopy can be achieved, in one or two sessions, even in the presence of surgically-altered GI anatomy. The total procedure time is relatively short. For both antegrade and retrograde MSE procedures, propofol sedation seems sufficient and safe.

Motorized spiral enteroscopy: results of an international multicenter prospective observational clinical study in patients with normal and altered gastrointestinal anatomy

“…The available studies therefore do not report an increased rate of AEs 17 18 19 20 ; however, there is potential concern about an increased rate of AEs using the motorized technique. Recently, a study found no increase in the AE rate for MSE in patients who had undergone previous surgery 21 . In the current study, 21.5 % of the patients had previous abdominal surgery, with 10 % having surgically altered GI anatomy (40.8 % and 19.2 % of the CP2 group, respectively).…”

Safety of motorized spiral enteroscopy: is what we know today enough?

“…One study reported mild cardiopulmonary AEs related to general anesthesia in 3/132 patients (2.3 %) 1 ; in their series, Beyna et al reported two SAEs related to sedation/anesthesia 8 . Interestingly, Al-Toma et al performed 92 % of MSEs in their study with only propofol sedation, with no adverse events related to sedation reported 3 . Although the choice of sedation is usually governed by procedure complexity, clinical factors, and local organizational protocols 5 , future studies will have to clarify which is the most appropriate and safest sedation for antegrade MSE.…”

“…Conversely, MSE safety data are still scarce. The evidence on the safety of MSE in unselected populations is still based on a limited number of patients, approximately 750 from seven studies to date 1 2 3 4 6 7 8 . For MSE, minor adverse events (AEs), such as superficial mucosal tears, submucosal hematomas, and throat discomfort, are to be expected in about a quarter of patients 1 2 3 4 6 7 .…”

The return of the helix: an evaluation of motorized spiral enteroscopy in actual daily clinical practice; a few points to “torque” about and ponder upon…

“…Although Akerman et al first reported on the concept of motorized spiral enteroscopy (MSE) over a decade ago 1 , it has only recently been introduced into actual clinical practice 2 and our understanding of its safety and performance is still being fine-tuned. In this issue of Endoscopy , Al-Toma et al, from the Netherlands, report on their multicenter prospective uncontrolled study in a “real-world” setting, with a focus on performance and safety in “all-comers,” including patients with a previous history of surgery and altered anatomy 3 . Their study included 170 patients, with a median age of 64 years.…”

“…Another crucial and important point that should be borne in mind, which is specific to antegrade MSE, relates to the interaction of the raised spiral-moiety with the patient’s upper esophageal sphincter and esophagus. In their series, Al-Toma et al 3 elected not to predilate the upper esophageal sphincter with a bougie (as previously described 2 4 ), but alternatively avoided esophageal injury by aborting procedures where excessive resistance was encountered on insertion through the upper esophageal sphincter (n = 2). However, deep esophageal laceration (Buscaglia 4) from impaction of the spiral overtube in the upper esophagus on withdrawal (despite no resistance on insertion) has also been reported 8 , and clinicians should be alerted to this potential risk.…”