Diagnostic yield and technical performance of novel motorized spiral enteroscopy compared to single-balloon enteroscopy in suspected Crohn's disease: a prospective study.
Partha Pal, Piyush Vishwakarma, Aniruddha Pratap Singh, Palle Manohar Reddy, Mohan Ramchandani, Rupa Banerjee, Anuradha Sekaran, Polina Vijayalaxmi, Hardik Rughwani, Pradev Inavolu, Santosh Darishetty, Pradeep Rebala, Guduru Venkat Rao, Manu Tandan, D Nageshwar Reddy
Published in Oct 2022, Gastrointestinal endoscopy.
Background and aims
Both single-balloon enteroscopy (SBE) and 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).
Patients with suspected CD undergoing either SBE or NMSE between March 2021 to December 2021 in a high volume tertiary center were prospectively compared with regard to technical success (ability to reach lesion), diagnostic yield, depth of maximal insertion (DMI), procedure time and total enteroscopy rates.
177 suspected CD patients (37.2% female, 7-75 years) underwent total 201 DAE. The technical success was 83% (81.5 %: SBE; 87.3%: NMSE,p=0.61) impacting subsequent management in 92% (88.5%: SBE, 97.8%: NMSE,p=0.2). Technical success with antegrade NMSE was significantly higher (81.4%) than antegrade SBE (33.3%)(p=0.007) for lesions in proximal ileum and beyond. There was no significant difference in the diagnostic yield (80.8%: SBE and 83.6%: NMSE, p=0.65). Procedure time was significantly lower in both antegrade and retrograde NMSE [duration (min): median (range): antegrade: NMSE: 40(10-75),SBE: 60(20-180),p<0.0001; retrograde: NMSE: 25(20-60),SBE: 60(20-180), p<0.0001]. DMI was higher with antegrade NMSE [DMI (cm): median (range): NMSE: 400(70-600),SBE: 180(60-430),p <0.0001]. Total enteroscopy rate was higher with NMSE (37% vs 0.7% with SBE,p<0.0001). All adverse events were mild.
Both NMSE and SBE are safe and effective for small bowel evaluation in suspected CD. NMSE scores over SBE with regards to deeper small bowel evaluation with complete small bowel coverage and shorter procedure time.