Tu1609 Diagnostic Yield of Spiral Enteroscopy Compared to Balloon Enteroscopy

Abstract

Diagnostic Yield of Spiral Enteroscopy Compared to Balloon Enteroscopy Daniel Heller, Chakradhar M. Reddy, Henrique Fernandez, David Kerman, Javier Parra Department of Medicine, Mount Sinai Medical Center, Miami Beach, FL; Division of Gastroenterology, Miller School of Medicine, University of Miami, Miami, FL; Division of Gastroenterology, St. Mary-Corwin Medical Center, Pueblo, CO; Division of Gastroenterology, Gastroenterology Care Center, Miami, FL Background: Small bowel enteroscopy with double balloon enteroscopy (DBE) and single balloon enteroscopy (SBE) allows for diagnostic and therapeutic management of small bowel pathology. Spiral enteroscopy (SE) is a new technique which utilizes an overtube, twisting and pleating the small bowel allowing for advancement of the endoscope.Aim:The aim of the study is to compare spiral enteroscopy with balloon enteroscopy (DBE and SBE), and determine the utility in terms of diagnostic yield, interventions, depth of insertion, procedure time, and complications.Patients and Methods:All cases of small bowel enteroscopy done by the authors over a two year period were retrospectively analyzed. Results: 140 procedures were performed in 112 patients, mean age was 59.7 years (20 89), 48% were males. Obscure gastrointestinal (GI) bleeding was the most common indication (51%). 69 patients underwent 87 SBE/DBE (67 antegrade, 20 retrograde), and 43 patients underwent 53 SE (37 antegrade, 16 retrograde). The diagnostic yield of SBE/DBE was 82%, while SE was 70%. The most common finding of SBE/DBE was inflammation/ ulceration (46.5%), angioectasias (26.8%), strictures (12.7%), and neoplasia (8.5%). The most common finding of SE was inflammation/ ulceration (43.2%), angioectasias (35%), strictures (8%), and neoplasia (5.4%). 70% of SBE/ DBE procedures required an intervention, the most common were biopsy (53.3%), hemostasis (45%); 44% of these were bipolar coagulation, and stricture dilation (8%). 53% of SE required an intervention, the most common were biopsy (22%), hemostasis (22%); 71% of these were bipolar coagulation, intestinal stricture dilation (5%), and polypectomy (2%). The mean depth of insertion in the SBE/ DBE group was the proximal ileum, the cecum was reached in one case of antegrade enteroscopy. Six patients in the SBE/ DBE group underwent concurrent antegrade and retrograde endoscopy, and the entire GI tract was visualized in two patients. The mean depth of insertion in the SE group was the proximal ileum, the terminal ileum was reached in two cases of antegrade enteroscopy. In the SE group five patients underwent concurrent antegrade and retrograde endoscopy, the entire GI tract was visualized in one patient. 21 patients (16 SBE/ DBE, 5 SE) had previously undergone gastric bypass with Roux-en-Y reconstruction, the extruded stomach was reached in all 21 patients (100%). Common adverse events included sore throat, swallowing discomfort, abdominal bloating, transient hypoxia (2%), and cardiac arrhythmias (0.7%). There were no serious complications such as perforation or death. Conclusion: Spiral enteroscopy is an effective method for evaluation of the small bowel. The diagnostic yield, depth of insertion, and procedure time appear comparable to other deep small bowel enteroscopic (DBE, SBE) techniques.