Tu1616 The Findings, Tolerability and Safety of Spiral Enteroscopy in a Single UK Centre

Abstract

Tu1616 The Findings, Tolerability and Safety of Spiral Enteroscopy in a Single UK Centre Elizabeth A. Arthurs, Peter Marden, Stephen Hughes Gastroenterology, North Bristol NHS Trust, Bristol, United Kingdom Background: Spiral enteroscopy (SE) is an emerging technique for the evaluation and management of small bowel lesions. There is no published data concerning tolerability and safety of this technique under sedation in the UK. Aims: To report our single centre experience of the tolerability, safety and efficacy of SE in the investigation and management of small bowel pathology. Methods: A retrospective analysis of case notes of patients undergoing SE (March 2009 to November 2010) was performed. Patient demographics, indications, findings, treatment performed, tolerability and complications were analysed. Results: We performed 47 procedures in 43 patients. Forty five SEs were performed per oral and 2 per anum. Thirty patients were male and 17 female. Mean age was 68.8 (range 35 90). Indications for SE were anaemia (17), angiodysplasia (12), occult GI bleeding (7), polyps (5), upper GI bleeding/melaena (3), abnormal radiology (1), pain (1) and Peutz-Jegher syndrome (1). All procedures were performed under conscious sedation. Mean estimated depth of insertion in 39 patients was 212 cm (range 100 300 cm) per oral. Mean time for the procedure in 41 patients was 40 mins (range 15 80). Abnormalities were identified in 30 (63.8%) cases; these comprised angiodysplasia (22), small bowel diverticula (3), polyps (2), ulceration (2), lymphoma (1), Blue Rubber Bleb Naevus syndrome (1), presence of altered blood (1), lymphangiectases (2) and upper gastrointestinal pathology (GAVE, hiatus hernia, Barrett’s oesophagus). Seven patients had more than one abnormality. Therapy was performed in 24 cases (51.2%) and comprised APC (21), tattooing (8), multiple polypectomies (1), and dual therapy with injection of adrenaline and clipping/APC (2). Tolerance was recorded by the endoscopist and nursing staff as ‘good’, ‘fair’ or ‘poor’. Tolerance was recorded as ‘good’ in 34 (72.3%) cases, ‘fair’ in 8 (17%) cases and ‘poor’ in 5 (10.6%) cases. 1 patient suffered a complication mild hypotension and hypoxia which resolved with intravenous fluids and oxygen. There was 1 death within 30 days: a patient with ischaemic heart disease and cardiac failure (not procedure related). The main limitations of this technique were failure of the spiral to engage the small intestine adequately (3), impaction of the spiral in a large hiatus hernia (1) and in 1 patient SE did not visualise a tattoo placed previously at double balloon enteroscopy. Conclusions: In our experience, spiral enteroscopy appears to be a safe and effective way of diagnosing and treating small bowel pathology. It is safe to perform under conscious sedation and well tolerated in most patients.