Original article
Clinical Endoscopy
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)

https://doi.org/10.1016/j.gie.2022.10.017Get rights and content

Background and Aims

Both single-balloon enteroscopy (SBE) and the novel motorized spiral enteroscopy (NMSE) are effective techniques for device-assisted enteroscopy (DAE). To date, no study has prospectively compared both modalities in suspected Crohn’s disease (CD).

Methods

Patients with suspected CD undergoing either SBE or NMSE between March 2021 and December 2021 in a high-volume tertiary center were prospectively compared for technical success (ability to reach the lesion), diagnostic yield, depth of maximal insertion (DMI), procedure time, and total enteroscopy rates.

Results

One hundred seventy-seven patients (37.2% female; aged 7-75 years) with suspected CD underwent 201 DAEs. Technical success was 83% (SBE 81.5% vs NMSE 87.3%, P = .61) and impacted subsequent management in 92% (SBE 88.5% vs NMSE 97.8%, P = .2). Technical success with antegrade NMSE was significantly higher (81.4%) than antegrade SBE (33.3%, P = .007) for lesions in the proximal ileum and beyond. There was no significant difference in the diagnostic yield (SBE 80.8% vs NMSE 83.6%, P = .65). Median procedure time was significantly lower in both antegrade (NMSE, 40 minutes [range, 10-75]; SBE, 60 minutes [range, 20-180]; P < .0001) and retrograde (NMSE, 25 minutes [range, 20-60]; SBE, 60 minutes [range, 20-180]; P < .0001) NMSE. Median DMI was higher with antegrade NMSE (NMSE, 400 cm [range, 70-600]; SBE, 180 cm [range, 60-430]; P < .0001). The total enteroscopy rate was higher with NMSE (37% vs .7% with SBE, P < .0001). All adverse events were mild.

Conclusions

Both NMSE and SBE are safe and effective for small-bowel evaluation in suspected CD. NMSE is superior to SBE with regard to deeper small-bowel evaluation with complete small-bowel coverage and shorter procedure time.

Section snippets

Patients

Consecutive patients with suspected CD requiring small-bowel endoscopy based on clinical history and abnormal imaging (CTE or MRE) or CE with lesions not reachable by ileocolonoscopy were recruited between March 2021 and December 2021. The study was conducted in a high-volume tertiary GI center (Asian Institute of Gastroenterology) performing nearly more than 500 SBE and NMSE procedures per year with well-established inflammatory bowel disease registry with more than 7000 inflammatory bowel

Demographics

One hundred forty-six SBE (69 antegrade and 77 retrograde) and 55 NMSE (44 antegrade and 11 retrograde) procedures were performed in 131 and 46 patients, respectively, with suspected CD (37.2% female; aged 7-75 years [median, 35]). Other demographic features like age and sex distribution and percentage of pediatric cases, postoperative cases, and smoking history are summarized in Table 1.

Indications of DAE

The most common indication was abnormal cross-sectional imaging (CTE or MRE) in suspected CD, with 96.6%

Discussion

The current prospective study evaluated consecutive patients with suspected CD undergoing either SBE or NMSE. Among 131 patients with suspected CD undergoing 146 SBE procedures, technical success was 81.5%, which was noninferior to the overall technical success with NMSE (87.3%) performed in 46 patients (55 procedures) (P = .61). However, technical success was higher with NMSE when the location of the anticipated lesion was taken into consideration, being higher in lesions in the proximal ileum

References (25)

  • G. Holleran et al.

    The use of single balloon enteroscopy in Crohn's disease and its impact on clinical outcome

    Scand J Gastroenterol

    (2018)
  • P. Pal et al.

    Breaking the barrier in endoscopy

    J Digest Endosc

    (2021)
  • Cited by (8)

    View all citing articles on Scopus

    DISCLOSURE: All authors disclosed no financial relationships.

    View full text