Deep Enteroscopy: Which Technique Will Survive?

The advent of deep enteroscopy (DE) has dramatically changed diagnostic and therapeutic approaches to small bowel diseases. Unlike capsule endoscopy, which is unable to obtain biopsies or treat a disease, DE techniques have diagnostic and therapeutic capabilities. Double-balloon enteroscopy (DBE) was introduced in 2001, and single-balloon enteroscopy (SBE) and spiral enteroscopy (SE) were subsequently developed for small bowel investigation. In published reports comparing these different enteroscopy techniques, most comparative parameters (depth of insertion, complications, learning curve, diagnostic yield, and therapeutic yield) were comparable among DBE, SBE, and SE. However, the procedure duration appears to be shorter for SE than for DBE and SBE. The rate of complete enteroscopy is clearly superior for DBE, compared with SE and SBE. Because these results do not indicate an increase in diagnostic or therapeutic yield, the clinical impact of complete enteroscopy remains controversial. According to previous studies, the three DE methods seem to be equally effective and safe in the clinical setting. Although larger randomized controlled trials are needed to evaluate the procedural characteristics and clinical impact, the selection of an enteroscopic technique should be based on availability and the endoscopist's experience.

Spiral enteroscopy in diagnosis and managements of small bowel diseases / 中华消化内镜杂志

Objective To evaluate the use of spiral enteroscopy in diagnosis and treatment of smallbowel diseases.Methods The data of 8 patients who underwent spiral enteroscopy from July to September 2009 were retrospectively studied.The variables including maximal insertion depth,total procedure time,complications,and outcome were evaluated.Results The average maximal depth of intubation was 2.2 m beyond the Ligament of Triez (0-3.6 m beyond Ligament of Triez),with a mean procedure time at 41 min (25 to 77 min).Small bowel Crohn's disease was diagnosed in 2 cases with biopsy suggesting active inflammation and granular formation.Small intestinal tumor was detected in 1 patient with pathological finding of high grade dysplasia.Jejunal ulcer was detected in 1 patient.Multiple polyps were found in 1 patient after jejunal anastomosis,which were then treated with endoscopic argon plasma coagulation (APC).No abnormalities were found in 3 other patients.No complications occurred during and after the procedure.The maneuver of spiral enteroscopy and APC were same as that of balloon enteroscopy.Conclusion Spiral enteroscopy is simple and convenient to operate,which is of great potential in clinical use.