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Motorized Spiral Enteroscopy Is Effective in Patients with Prior Abdominal Surgery
Antonio Giordano1,2, Gherzon Casanova1, Miriam Escapa1
1Endoscopy Unit, Gastroenterology Department, ICMDM, Hospital Clinic of Barcelona, Barcelona, Spain.
Background:
Motorized Spiral Enteroscopy (MSE) reduces procedure time and increases insertion depth into the small bowel; however, there is scarce evidence on factors affecting MSE efficacy.
Aims:
To evaluate diagnostic yield and adverse events of MSE including patients with prior major abdominal surgery.
Methods:
A prospective observational study was conducted on patients undergoing MSE from June 2019 to December 2021. Demographic characteristics, procedure time, depth of maximum insertion (DMI), technical success, diagnostic yield, and adverse events were collected.
Results:
Seventy-four anterograde (54.4%) and 62 retrograde (45.6%) enteroscopies were performed in 117 patients (64 males, median age 67 years). Fifty patients (42.7%) had prior major abdominal surgery. Technical success was 91.9% for anterograde and 90.3% for retrograde route. Diagnostic yield was 71.6% and 61.3%, respectively. The median DMI was 415 cm (264-585) for anterograde and 120 cm (37-225) for retrograde enteroscopy. In patients with prior major abdominal surgery, MSE showed significantly longer small bowel insertion time (38 vs 29 min, p = 0.004), with similar diagnostic yield (61 vs 71.4%, p = 0.201) and DMI (315 vs 204 cm, p = 0.226). The overall adverse event rate was 10.3% (SAE 1.5%), with no differences related to prior abdominal surgery (p = 0.598). Patients with prior surgeries directly involving the gastrointestinal tract showed lower DMI (189 vs 374 cm, p = 0.019) with equal exploration time (37.5 vs 38 min, p = 0.642) compared to those with other abdominal surgeries.
Conclusions:
MSE is effective and safe in patients with major abdominal surgery, although longer procedure times were observed. A lower depth of insertion was detected in patients with gastrointestinal surgery.
Insights
Motorized Spiral Enteroscopy (MSE) is effective and safe for patients with prior abdominal surgery. While procedure times may be longer, diagnostic yield remains comparable, though depth of insertion may decrease with gastrointestinal surgery history.
Area of Science:
- Gastroenterology
- Endoscopy
- Surgical Innovation
Background:
- Motorized Spiral Enteroscopy (MSE) enhances small bowel intubation depth and reduces procedure duration.
- Evidence on factors influencing MSE efficacy, particularly in patients with prior abdominal surgery, is limited.
Purpose of the Study:
- To assess the diagnostic yield and safety of MSE in patients with and without a history of major abdominal surgery.
- To identify factors affecting MSE performance, including depth of insertion and procedure time.
Main Methods:
- A prospective observational study involving 117 patients undergoing MSE between June 2019 and December 2021.
- Data collected included patient demographics, prior surgical history, procedure time, maximum insertion depth (DMI), technical success, diagnostic yield, and adverse events.
Main Results:
- Technical success rates were high (91.9% anterograde, 90.3% retrograde).
- Overall diagnostic yield was 71.6% anterograde and 61.3% retrograde.
- Patients with prior major abdominal surgery experienced longer insertion times (38 vs. 29 min) but similar diagnostic yield and DMI compared to controls.
- Those with prior gastrointestinal surgery had significantly lower DMI (189 cm) than those with other abdominal surgeries (374 cm).
- The overall adverse event rate was 10.3%, with no significant difference based on prior abdominal surgery.
Conclusions:
- MSE is a safe and effective endoscopic tool for evaluating the small bowel in patients with prior major abdominal surgery.
- While MSE demonstrates comparable diagnostic yield, longer procedure times and potentially reduced insertion depth in patients with a history of gastrointestinal surgery should be considered.
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