OC-024 Spinning through the small bowel: first report of the UK (multicentre) experience of spiral enteroscopy

Abstract

Introduction This decade has witnessed a revolution in small bowel (SB) endoscopy. Balloon assisted enteroscopy (double-balloon and later single-balloon) has dramatically expanded the capacity to endoscopically manage SB pathology. More recently, a novel device assisted enteroscopy named spiral enteroscopy (SE) is a promising alternative method of deep enteroscopy. SE uses a pliable plastic spiral threaded onto a flexible overtube (Spirus, Endoase Discovery SB, Spirus Medical, Massachusetts, USA). Rotational torque applied to the overtube allows the spiral thread to engage the SB. This advances the overtube and enteroscope deeper into the small bowel. Methods We report an early multicentre experience of SE since its introduction to the UK in November 2008. Results 23 procedures (12 male) were done at two tertiary referral centres. Mean age was 58 years (19–81 years). 11 procedures were done under conscious sedation while the remaining 12 were under general anaesthesia. 22 procedures were performed via the oral route; 1 procedure was done via the rectal route. Carbon dioxide was used as an insufflating gas in 13 procedures while air was used for rest. The most common indication for SE was mid-gut bleeding (n=17). Other indications included SB polyposis (n=5) and direct percutaneous endoscopic jejunostomy (DPEJ) feeding tube replacement (n=1). 22 procedures were continued to the maximal point of insertion until forward advancement of the enteroscope ceased. One oral procedure was aborted due to the presence of gastric contents despite a 14-hour fast. Mean duration of procedures was 42±12 min. In one patient, where the spiral engaged the SB throughout the procedure, pan-enteroscopy was achieved in 65 min. In the patient undergoing rectal SE, SB intubation distance was estimated to be 50 cm proximal to the ICV. Eight patients were treated with argon plasma coagulation for angioectasias and one patient had multiple polypectomies. In one patient, the overtube induced some minor submucosal bruising; the patient remained well after the procedure. No other complications ensued. The main limitation to SE was related to occasional inability of the spiral to engage the SB. In another two patients, the SE failed to reach the location of SB tattoos placed at previous DBEs. In another patient, SE failed to reach a proximal ileal polyp (subsequently reached by DBE in the same session). Conclusion The initial UK experience with SE suggests that where SB engagement readily occurs, deep SB intubation can be achieved in a relatively short time. Anecdotally, the SE also appears to provide a stable platform for therapeutic interventions. Further comparative studies would be helpful.