Performance and adverse events of the motorized power spiral enteroscopy (PSE) in a case series at Eastern Europe: a single tertiary center experience

Aims Motorized power spiral enteroscopy (PSE) was introduced as a promising new technique, that offers easier, faster, and more complete small bowel deep enteroscopy. There were reports of small bowel perforations and death, during PSE and withdrawal from the market of the device, due to these adverse events. The aim of our study was to evaluate the performance, efficacy, and safety and to report the adverse events, found during PSE in our clinical practice at a single tertiary endoscopy center in Eastern Europe.

Methods We retrospectively evaluated all consecutive patients undergoing PSE at the Department of Gastroenterology in University Hospital “Tsaritsa Yoanna – ISUL”, Sofia, Bulgaria from June 2020 through December 2022. We have used PSF-1;(Olympus Medical Systems, Tokyo, Japan) and all patients were intubated during the procedure. Our primary outcomes were diagnostic and therapeutic yield, technical success, a success rate of pan-enteroscopy, depth of insertion and adverse events

Results A total of 20 procedures in 17 patients (60% males, mean age 54±14 years) were performed. In 11 patients from antegrade and 6 from retrograde approach, in 3 patients was both. The depth of insertion was considered sufficient when a target lesion was found and the calculated technical success rate was 81% (9/11) of the antegrade route and 83% (5/6) of the retrograde route. In a combined approach, a 66% (2/3) target was reached. The total pan-enteroscopy rate was 30% (6/20) in all procedures, and 36% (4/11) for the anterograde approach to reach the cecum. Calculated overall diagnostic accuracy was 81.82% (95% CI). The median insertion time was 75 min for the antegrade and 70 min for the retrograde approach, respectively. Overall adverse events were found in 35% (6/17) patients with transient mild abdominal pain and swallowing discomfort. Severe complications and major adverse events occurred in 23% (4/17) of the patients. One patient suffered from intussusception of the sigmoid after PSE, which was resolved in open surgery. Three patients developed severe bradycardia and hypoventilation, which needed intensive care unit, to resolve after 24-72 hours. There were no perforations found or deaths of the patients due to PSE in our cohort. [1] [2]

Conclusions In our case series examined by PSE during a two-year period, we found high diagnostic accuracy of the enteroscopy method, but we report a high complication rate with approximately one-third of major adverse events in our patient cohort due to PSE. Further technological development and innovation of the endoscopes are needed with the proper learning curve of the endoscopists to support patient safety.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Falt P, Urban O.. Motorized spiral enteroscopy – a prospective analysis of 82 procedures at a single tertiary center. Scand J Gastroenterol [Internet] 2023; 58 (10) 1207-1212
• 2 Singh P, Singla V, Bopanna S, Shawl MR, Garg P, Agrawal J, Arya A, Mittal V, Bhargava R, Madan K.. Safety and efficacy of the novel motorized power spiral enteroscopy: A single-center experience DEN Open [Internet]. 2023; 3 01.

Publication History

Article published online:
15 April 2024