Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India; Department of Pathology, Asian Institute of Gastroenterology, Hyderabad, India.
Gastrointest Endosc. 2023 Mar;97(3):493-506. doi: 10.1016/j.gie.2022.10.017. Epub 2022 Oct 21.
Both single-balloon enteroscopy (SBE) and the novel motorized spiral enteroscopy (NMSE) are effective techniques for device-assisted enteroscopy (DAE). To date, no study has prospectively compared both modalities in suspected Crohn's disease (CD).
Patients with suspected CD undergoing either SBE or NMSE between March 2021 and December 2021 in a high-volume tertiary center were prospectively compared for technical success (ability to reach the lesion), diagnostic yield, depth of maximal insertion (DMI), procedure time, and total enteroscopy rates.
One hundred seventy-seven patients (37.2% female; aged 7-75 years) with suspected CD underwent 201 DAEs. Technical success was 83% (SBE 81.5% vs NMSE 87.3%, P = .61) and impacted subsequent management in 92% (SBE 88.5% vs NMSE 97.8%, P = .2). Technical success with antegrade NMSE was significantly higher (81.4%) than antegrade SBE (33.3%, P = .007) for lesions in the proximal ileum and beyond. There was no significant difference in the diagnostic yield (SBE 80.8% vs NMSE 83.6%, P = .65). Median procedure time was significantly lower in both antegrade (NMSE, 40 minutes [range, 10-75]; SBE, 60 minutes [range, 20-180]; P < .0001) and retrograde (NMSE, 25 minutes [range, 20-60]; SBE, 60 minutes [range, 20-180]; P < .0001) NMSE. Median DMI was higher with antegrade NMSE (NMSE, 400 cm [range, 70-600]; SBE, 180 cm [range, 60-430]; P < .0001). The total enteroscopy rate was higher with NMSE (37% vs .7% with SBE, P < .0001). All adverse events were mild.
Both NMSE and SBE are safe and effective for small-bowel evaluation in suspected CD. NMSE is superior to SBE with regard to deeper small-bowel evaluation with complete small-bowel coverage and shorter procedure time.
单气囊小肠镜（SBE）和新型电动螺旋小肠镜（NMSE）均为辅助小肠镜检查（DAE）的有效技术。迄今为止，尚无研究前瞻性比较过这两种方法在疑似克罗恩病（CD）中的应用。
2021 年 3 月至 2021 年 12 月，在一家大容量的三级中心，前瞻性比较了疑似 CD 患者行 SBE 或 NMSE 的情况，比较的指标有技术成功率（到达病变的能力）、诊断率、最大插入深度（DMI）、手术时间和全小肠镜率。
177 例（37.2%为女性；年龄 7-75 岁）疑似 CD 患者接受了 201 次 DAE。技术成功率为 83%（SBE 为 81.5%，NMSE 为 87.3%，P=.61），92%的患者因技术成功率高而改变了后续治疗方案（SBE 为 88.5%，NMSE 为 97.8%，P=.2）。对于近端回肠及以上部位的病变，经 NMSE 行逆行检查的技术成功率（81.4%）明显高于 SBE 组（33.3%，P=.007）。SBE 和 NMSE 的诊断率（SBE 为 80.8%，NMSE 为 83.6%，P=.65）无显著差异。两种方法的手术时间均明显缩短（经 NMSE 行逆行检查时，SBE 为 40 分钟[范围 10-75]，NMSE 为 40 分钟[范围 10-75]；经 NMSE 行顺行检查时，SBE 为 60 分钟[范围 20-180]，NMSE 为 60 分钟[范围 20-180]；P<0.0001）。经 NMSE 行逆行检查时，DMI 中位数也明显较高（NMSE 为 400cm[范围 70-600]，SBE 为 180cm[范围 60-430]；P<0.0001）。NMSE 的全小肠镜率（37%）明显高于 SBE（7%，P<0.0001）。所有不良事件均为轻度。
NMSE 和 SBE 均安全、有效，可用于疑似 CD 的小肠评估。NMSE 在更深入的小肠评估、全小肠覆盖和更短的手术时间方面优于 SBE。
