Japan Digestive Disease Week 2022
Invited Lecture (JGES)
October 28, 14:00–14:30, Room 4 (Fukuoka International Congress Center Maun Hall)
Invited Lecture-13
Motorized spiraled enteroscope : Efficacy and safety
- Institute Arnault Tzanck
AIM: Motorized spired Enteroscopy (MSE) is a new equipment developed by Olympus in order to improve small bowel exploration. It is based on manual spiral enterocope design by Ackerman with our JGES presentation in 2011. The goal of our study was to assess its efficacy and safety on clinical practice on patients with small bowel diseases.
Method and patients: It is a prospective study in France where we were the first center to introduce this new endoscopic tool. The primary end point was the diagnosis yield in patents with abnormalities observed mostly during video capsule endoscopy. The secondary end points were percentage of diagnosis yield, percentage of therapeutic enteroscopy; side-effects related to procedure and handling of the procedure.
RESULTS: from July 2019 to March 2022, 170 procedures were performed in 163 patients (mean age 74,4 years old +/- 12,4; men 92, female 78).76,4 % of patients had cardiovascular disease with at least antiplatelet drugs or anticoagulant treatment.
Main indications were suspected or occult gastro-intestinal bleeding (127 patients ,74,7%), iron deficiency anemia (26 patients), suspected small bowel inflammation (9 patients) and one case of capsule retention.
Diagnosis yield of our study was 61,1% (104/170): angiodysplasias 45,2% (77/170); polyps or carcinomas (4,7%; 8/170); inflammation (6,4%, 11/170), and miscellaneous lesions (3% ,5/170). Therapeutic endoscopy was performed in 52% of cases (92/170).
Side-effects were observed in 47 patients (27,6%) but mostly minors mucosal damages without any clinical outcome. No pancreatitis or perforation were observed.
Handling of the procedure required training and endoscopic expertise, but the overall benefit is important. In clinical study MSE is faster than single balloon or double balloon enteroscopy. As show by Neuhaus al it allows deeper ileal insertion from the oral route. The two tricky points are: esophageal intubation was in our center deep propofol sedation did not require general anesthesia and duodenal-jejunal flexure were gentle in and out movements are important to insert the rotating part inside jejunum, then intubation of jejunum and ileum is easy and fast. Large operating channel and waterjet allow therapeutic endoscopy with a very stable position due to the spiral part.
conclusion: our study shows excellent results of this equipment and overhold safety in routine clinical practice as enteroscopy is often necessary in videocapsule expert center.
Method and patients: It is a prospective study in France where we were the first center to introduce this new endoscopic tool. The primary end point was the diagnosis yield in patents with abnormalities observed mostly during video capsule endoscopy. The secondary end points were percentage of diagnosis yield, percentage of therapeutic enteroscopy; side-effects related to procedure and handling of the procedure.
RESULTS: from July 2019 to March 2022, 170 procedures were performed in 163 patients (mean age 74,4 years old +/- 12,4; men 92, female 78).76,4 % of patients had cardiovascular disease with at least antiplatelet drugs or anticoagulant treatment.
Main indications were suspected or occult gastro-intestinal bleeding (127 patients ,74,7%), iron deficiency anemia (26 patients), suspected small bowel inflammation (9 patients) and one case of capsule retention.
Diagnosis yield of our study was 61,1% (104/170): angiodysplasias 45,2% (77/170); polyps or carcinomas (4,7%; 8/170); inflammation (6,4%, 11/170), and miscellaneous lesions (3% ,5/170). Therapeutic endoscopy was performed in 52% of cases (92/170).
Side-effects were observed in 47 patients (27,6%) but mostly minors mucosal damages without any clinical outcome. No pancreatitis or perforation were observed.
Handling of the procedure required training and endoscopic expertise, but the overall benefit is important. In clinical study MSE is faster than single balloon or double balloon enteroscopy. As show by Neuhaus al it allows deeper ileal insertion from the oral route. The two tricky points are: esophageal intubation was in our center deep propofol sedation did not require general anesthesia and duodenal-jejunal flexure were gentle in and out movements are important to insert the rotating part inside jejunum, then intubation of jejunum and ileum is easy and fast. Large operating channel and waterjet allow therapeutic endoscopy with a very stable position due to the spiral part.
conclusion: our study shows excellent results of this equipment and overhold safety in routine clinical practice as enteroscopy is often necessary in videocapsule expert center.