Pal Partha, Ramchandani Mohan, Banerjee Rupa, Viswakarma Piyush, Singh Aniruddha Pratap, Reddy Manohar, Rughwani Hardik, Patel Rajendra, Sekaran Anuradha, Kanaganti Swathi, Darisetty Santosh, Nabi Zaheer, Singh Jagadish, Gupta Rajesh, Lakhtakia Sundeep, Pradeep Rebala, Venkat Rao G, Tandan Manu, Reddy D Nageshwar
Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
Gut. 2023 Oct;72(10):1866-1874. doi: 10.1136/gutjnl-2023-329885. Epub 2023 May 17.
Recent studies have shown that motorised spiral enteroscopy (MSE) enables deeper and total small bowel evaluation compared with single-balloon enteroscopy (SBE) in suspected Crohn's disease (CD) when analysed per procedure. However, no randomised controlled study has compared bidirectional MSE with bidirectional SBE in suspected CD.
Patients with suspected CD requiring small bowel enteroscopy were randomly assigned to either SBE or MSE between May 2022 and September 2022 in a high volume tertiary centre. Bidirectional enteroscopy was done if intended lesion could not be reached on unidirectional study. Comparison was made with regard to technical success (ability to reach lesion), diagnostic yield, depth of maximal insertion (DMI), procedure time and total enteroscopy rates. Depth:time ratio was calculated to avoid confounding for the location of lesion.
Among 125 suspected patients with CD (28% female, 18-65 years, median 41 years), 62 and 63 underwent MSE and SBE, respectively. The overall technical success (98.4 %: MSE, 90.5 %: SBE; p=0.11), diagnostic yield (95.2%: MSE; 87.3%: SBE, p=0.2) and procedure time were not significantly different. However, MSE appeared to have higher technical success (96.8% vs 80.7%, p=0.08) in deeper small bowel (distal jejunum/proximal ileum) with higher DMI, higher depth:time ratio and total enteroscopy rates when attempted (77.8% vs 11.1%, p=0.0007). Both the modalities were safe although minor adverse events were more common with MSE.
MSE and SBE have comparable technical success and diagnostic yield for small bowel evaluation in suspected CD. MSE scores over SBE with regard to deeper small bowel evaluation with complete small bowel coverage and higher depth of insertion in a shorter time.
NCT05363930.
近期研究表明，在对疑似克罗恩病（CD）进行单次检查分析时，与单气囊小肠镜检查（SBE）相比，电动螺旋小肠镜检查（MSE）能够对小肠进行更深入和全面的评估。然而，尚无随机对照研究比较双向MSE与双向SBE在疑似CD中的应用。
2022年5月至2022年9月期间，在一家大型三级中心，将需要进行小肠镜检查的疑似CD患者随机分配至SBE组或MSE组。如果单向检查未能到达预期病变部位，则进行双向小肠镜检查。比较两组的技术成功率（到达病变部位的能力）、诊断率、最大插入深度（DMI）、检查时间和全小肠镜检查率。计算深度：时间比以避免病变位置造成的混淆。
在125例疑似CD患者中（女性占28%，年龄18 - 65岁，中位年龄41岁），分别有62例和63例接受了MSE和SBE检查。总体技术成功率（MSE为98.4%，SBE为90.5%；p = 0.11）、诊断率（MSE为95.2%，SBE为87.3%，p = 0.2）和检查时间无显著差异。然而，在更深的小肠（空肠远端/回肠近端）中，MSE的技术成功率似乎更高（96.8%对80.7%，p = 0.08），DMI更高，深度：时间比更高，尝试时的全小肠镜检查率也更高（77.8%对11.1%，p = 0.0007）。两种检查方式均安全，尽管MSE的轻微不良事件更为常见。
在疑似CD的小肠评估中，MSE和SBE的技术成功率和诊断率相当。在对小肠进行更深入评估、实现全小肠覆盖以及在更短时间内达到更高插入深度方面，MSE优于SBE。
NCT05363930。
