Motorized spiral enteroscopy bests single-balloon in deeper bowel evaluation for Crohn’s
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Key takeaways:
- Overall technical success, diagnostic yield did not differ between motorized spiral enteroscopy and single-balloon enteroscopy for suspected CD.
- MSE outscored SBE in deeper bowel evaluation and procedure time.
Motorized spiral enteroscopy may have a technical advantage over single-balloon enteroscopy in reaching mid-small bowel lesions and examining a greater length of bowel in a shorter period of time in patients with suspected Crohn’s disease.
“Device-assisted enteroscopy is indicated for diagnosis of Crohn’s disease when it is suspected based cross-sectional imaging like CT/MR enterography or capsule endoscopy,” Partha Pal, MD, DNB, MRCP, ESEGH, a consultant gastroenterologist at the Asian Institute of Gastroenterology, told Healio. “Earlier studies on single- and double-balloon enteroscopy have shown a high diagnostic yield of more than 70% in suspected Crohn’s disease, which impacted subsequent management significantly.
“The recently introduced, novel motorized spiral enteroscopy in 2016 was shown to have high diagnostic yield, greater depth of insertion and higher total enteroscopy rates in earlier studies. However, when we systematically reviewed the literature, we found that there were certain knowledge gaps.”
Seeking to compare bidirectional motorized spiral enteroscopy (MSE) and bidirectional single-balloon enteroscopy (SBE) in individuals with suspected CD, Pal and colleagues recruited 125 patients (median age, 41 years; 28% women) at a high-volume tertiary care center to undergo MSE (n = 62) or SBE (n = 63) between May 2022 and September 2022. Researchers compared ability to reach lesions, diagnostic yield, depth of maximal insertion, procedure time and total enteroscopy rates between methods.
While comparable outcomes were reported between MSE and SBE in overall technical success (98.4% vs. 90.5%, respectively), diagnostic yield (95.2% vs. 87.3%) and procedure time, MSE had higher technical success (96.8% vs. 80.7%) in deeper small bowel areas of the jejunum and proximal ileum, with higher depth of maximal insertion. MSE also yielded higher depth-to-time ratio and total enteroscopy rates (77.8% vs. 11.1%).
According to Pal, both modalities “impact diagnosis and management,” although “minor adverse events” were more common in patients who underwent MSE.
“With the availability of various modalities of enteroscopy, these results will help to guide the clinician in choosing the optimal mode of deep enteroscopy in suspected small bowel CD, based on localization in cross-sectional imaging or capsule endoscopy,” Pal said. “For example, MSE may be preferable for deeper mid-small bowel lesions and when total enteroscopy is warranted. Higher depth of insertion in a shorter time has the potential to reduce endoscopist fatigue during long enteroscopy procedures.”
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