Spiral Enteroscopy Is Safe and Effective for an Elderly United States Population of Patients With Numerous Comorbidities

Abstract

Preliminary studies performed outside of the United States demonstrated that spiral enteroscopy is safe and effective when performed in young, healthy patients. However, spiral enteroscopy has not been evaluated in a US population of patients with numerous comorbidities. We evaluated the feasibility, efficacy, and safety of spiral enteroscopy in a US population of older patients with multiple comorbidities and a high prevalence of pathologic findings. We performed a prospective case series of 61 patients with clinical indications for deep enteroscopy conducted at 2 US academic tertiary referral centers. Patients underwent deep enteroscopy with the spiral Endo-Ease Discovery SB overtube. Insertion depth, procedure time, diagnostic findings, therapeutic maneuvers, sedation type, and complications were recorded. Spiral enteroscopy was attempted in 61 patients (mean age, 65.4 +/- 12.4 years); 52% were rated by American Society of Anesthesiologists guidelines as class 3 (n = 30) or 4 (n = 2). The procedure was successfully completed in 56 of 61 patients (92%). Average insertion depth was 217.4 +/- 79 cm beyond the ligament of Treitz. The total mean procedure time was 41 +/- 15 minutes (diagnostic time, 36 +/- 12 minutes; therapy time, 5 +/- 9 minutes). Positive findings were noted in 36 cases (59%), with therapeutic maneuvers performed in 30 cases (49%). A total of 41 cases (67%) were performed under conscious sedation; fluoroscopy was not used in any case. Four mild complications occurred, and there were no perforations. Spiral enteroscopy is technically feasible and safe in an elderly US population of patients with numerous comorbidities.