Is Motorized Spiral Enteroscopy Superior to Double Balloon Enteroscopy?

Motorized spiral enteroscopy and double balloon enteroscopy have similar success rates.

Among patients who underwent device-assisted enteroscopy, no significant differences occurred in the technical, diagnostic, and therapeutic success rates between those who had motorized spiral enteroscopy (MSE) and those who had a double balloon enteroscopy (DBE), according to a study in Gastrointestinal Endoscopy.

Investigators compared the diagnostic yield, therapeutic success, and complication rates between MSE and DBE in a propensity-matched cohort of patients who required small bowel evaluation. The patients underwent device-assisted enteroscopy at a hospital in Singapore from January 2014 through January 2022.

Inclusion criteria for DBE (Fujifilm, Japan) and MSE (PowerSpiral, Olympus Medical Systems Corporation) were identical: patients were aged 18 years and older with suspected small bowel disease and had consented to receive deep enteroscopy.

The primary outcome was a comparison of the technical and diagnostic success rates between DBE and MSE.

Compared with the current standard of care DBE, the procedure time, diagnostic yield, and therapeutic success rate were similar.

Before matching, 121 patients had deep enteroscopy (82 patients underwent DBE, and 39 underwent MSE). After 1:2 propensity score-matching, 31 MSE patients (median age, 65 years; men, 64.5%) were compared with 62 DBE patients (median age, 62 years; men, 64.5%). In the matched cohort, a significantly higher proportion of patients in the DBE group had a therapeutic enteroscopy vs the MSE group (DBE 82.3% vs MSE 54.8%, P =.007).

No significant difference was found in the technical success rate between the DBE and MSE groups (DBE 98.4% vs MSE 96.8%, P =.62). The diagnostic success rate also was similar between the DBE and MSE groups (66.1% vs 54.8%, respectively, P =.25). Inflammatory lesions, neoplastic lesions/polyps, and bleeding lesions were the most frequent findings. In addition, the therapeutic success rate was not significantly different between the DBE and MSE cohorts (62.8% vs 52.9%, respectively, P =.62).

In the unmatched cohort, complications occurred in 12 patients (DBE, n=1; MSE, n=11). The complication in the DBE group was minor (grade 1) and did not require endoscopic or surgical intervention. Most complications in the MSE group were minor (grades 1 to 2; n=10), primarily involving a superficial mucosal tear. Of this group of 10 patients, 2 had deep lacerations (grade 2) in the proximal esophagus requiring hospitalization, administration of analgesia, and close monitoring. The other MSE case was a serious adverse event (grade 3B) and involved a perforation in the ileum during a retrograde MSE, which led to laparotomy and surgical repair.

Limitations include the retrospective design, and the study was not adequately powered for subgroup analysis according to surgical anatomy and therapy type.

“The MSE represents significant progress compared to the previous spiral enteroscopy,” the study authors wrote. “The active motorized scope platform only requires a short learning curve for a trained endoscopist and can considerably decrease the resource use for an enteroscopy exam. However, compared with the current standard of care DBE, the procedure time, diagnostic yield, and therapeutic success rate were similar.”

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.

References:

Chan W, Wei LK, Tan T, et al. Motorized spiral enteroscopy versus double balloon enteroscopy: a case-matched study. Gastrointest Endosc. Published online October 10, 2022. doi:10.1016/j.gie.2022.09.030