The spiral enteroscopy training initiative: results of a prospective study evaluating the Discovery SB overtube device during small bowel enteroscopy (with video)

Background and aim: Indications for small-bowel enteroscopy are increasing, but advancing the endoscope to the ileum remains challenging, especially for less experienced operators. The aim was to evaluate the ease of use, safety, and efficacy of the Discovery SB overtube (Spirus Medical, Stoughton, Massachusetts, USA) during SB enteroscopy by physicians with no experience of the device.

Patients and methods: Thirty-three ”untrained“ endoscopists performed spiral enteroscopy during one of four 2-day training modules. Data were prospectively collected. Patient demographics, depth and time to maximal insertion, total procedure time, and findings were recorded. Trauma was documented during scope withdrawal. Day 1 and day 2 results were compared.

Results: Ninety procedures were successfully performed in 95 patients (72.6 % women, age = 48.8 ± 14.2 years). Endoscopists each performed a mean of five procedures. Mean time to maximal insertion was 20.9 ± 6.4 minutes. Mean depth achieved was 262.0 ± 57.4 cm. Total procedure time was 33.6 ± 8.0 minutes. In 90.3 %, 94.6 %, and 83.9 % of patients, respectively, a trauma score less than 3 was recorded in the esophagus, stomach, and intestine (scale = 0 – 5). There were no perforations, nor significant associations between trauma score and patient age, body mass index, depth of insertion, time to maximal insertion, total procedure time, or day 1 vs. day 2 procedures. Depth of insertion was greater on day 2 than on day 1 (276.9 ± 53.7 cm vs. 252.0 ± 58.0 cm, P = 0.043).

Conclusions: Discovery SB provides safe advancement of the enteroscope into the distal small bowel. Maximum depth of insertion appears comparable to that of balloon enteroscopy while taking less time. The device is easy to use and may be effectively operated in as few as five training cases.

References

• 1 Iddan G, Meron G, Glukhovsky A. et al . Wireless capsule endoscopy.  Nature. 2000;  405 417
• 2 Meron G D. The development of the swallowable video capsule M2A.  Gastrointest Endosc. 2000;  52 817-819
• 3 ASGE T echnology. Wireless capsule endoscopy.  Gastrointest Endosc. 2002;  56 621-624
• 4 Ell C, Remke S, May A. et al . The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding.  Endoscopy. 2002;  34 685-689
• 5 Herreiras J M, Caunedo A, Rodriguez-Tellez M. et al . Capsule endoscopy in patients with suspected Crohn’s disease in negative endoscopy?.  Endoscopy. 2003;  35 1-5
• 6 Bardan E, Nadler M, Chowers Y. et al . Capsule endoscopy for the evaluation of patients with chronic abdominal pain.  Endoscopy. 2003;  35 688-689
• 7 Vasquez-Iglesias J, Gonzalez-Conde B, Estevez-Prieto E. et al . A prospective study of COX-2 inhibitors versus nonspecific NSAIDs induced small bowel lesions using video capsule endoscopy.  Endoscopy. 2003;  35 A183
• 8 Yamamoto H, Sekine Y, Sato Y. et al . Total enteroscopy with a nonsurgical steerable double-balloon method.  Gastrointest Endosc. 2001;  53 216-220
• 9 Tsujikawa T, Saitoh Y, Andoh A. et al . Novel single-balloon enteroscopy for diagnosis and treatment of the small intestine: preliminary experiences.  Endoscopy. 2008;  40 11-15
• 10 Gross S A, Stark M E. Initial experience with double-balloon enteroscopy at a U.S. center.  Gastrointest Endosc. 2008;  67 890-897
• 11 Di Caro S, May A, Heine D G. et al . The European experience with double-balloon enteroscopy: indications, methodology, safety, and clinical impact.  Gastrointest Endosc. 2005;  62 545-550
• 12 May A, Nachbar L, Ell C. Double-balloon enteroscopy (push-and-pull-enteroscopy) of the small bowel: feasibility and diagnostic and therapeutic yield in patients with suspected small bowel disease.  Gastrointest Endosc. 2005;  62 62-70
• 13 Akerman P A, Cantero D, Avila J. et al . A pilot study of spiral enteroscopy using a new design 48F Discovers SB overtube and the Olympus 200 cm × 9.2 mm enteroscope.  Gastrointest Endosc. 2008;  67(5) AB264
• 14 Akerman P A, Cantero D, Avila J. et al . A pilot study of spiral enteroscopy using a new design 48F Discovers SB overtube and the Fujinon 200 cm × 9.4 mm enteroscope.  Gastrointest Endosc. 2008;  67(5) AB265
• 15 Akerman P A, Cantero D, Avila J. et al . The spiral enteroscopy experience in 101 consecutive patients: safety and efficacy using the Discovery SB.  Gastrointest Endosc. 2008;  67(5) AB92-93
• 16 Yamamoto H, Kita H. Double-balloon endoscopy: from concept to reality.  Gastrointest Endosc Clin N Am. 2006;  16 347-361
• 17 Lakatos P L, Fuszek P, Horvath H C. et al . Double-balloon enteroscopy for the diagnosis and treatment of obscure bleeding, inflammatory bowel diseases and polyposis syndromes: we see more but do we know more?.  Hepatogastroenterology. 2008;  55 133-137
• 18 Kamalaporn P, Cho S, Basset N. et al . Double-balloon enteroscopy following capsule endoscopy in the management of obscure gastrointestinal bleeding: outcome of a combined approach.  Can J Gastroenterol. 2008;  22 491-495
• 19 Fry L C, Bellutti M, Neumann H. et al . Utility of double-balloon enteroscopy for the evaluation of malabsorption.  Dig Dis. 2008;  26 134-139
• 20 Hartmann D, Eickhoff A, Tamm R. et al . Balloon-assisted enteroscopy using a single-balloon technique.  Endoscopy. 2007;  39(Suppl 1) E276
• 21 Mönkemüller K, Fry L C, Bellutti M. et al . ERCP using single-balloon instead of double-balloon enteroscopy in patients with Roux-en-Y anastomosis. [DOI: 10.1055/s-2007 – 966 949].  Endoscopy. 2008;  40 E19-E20
• 22 Cantero D, Monier C, Toor A. et al . Spirus EndoEase: multi-center experience with a new colonoscopy assist device.  Gastrointest Endosc. 2007;  65(5) AB126
• 23 Akerman P A, Cantero D, Agrawal D. et al . Novel method of enteroscopy via anal approach using EndoEase Discovery SB overtube.  Gastrointest Endosc. 2007;  65(5) AB277