OC-082 Spiral enteroscopy—the North Bristol experience. (23rd September 2015) - Gavin, D
Abstract : Introduction: Direct endoscopic inspection of the small bowel is challenging due to limitations of the equipment and techniques available and the anatomy of the small bowel itself. Capsule endoscopy allows visualisation of the small bowel mucosa but does not allow for biopsy or therapeutics. The advent of double balloon enteroscopy (DBE) has overcome many of these hurdles. However, it is a time consuming procedure and requires the purchase of extra equipment to inflate and deflate the balloons. Spiral enteroscopy utilises an over-tube with threaded vanes at the distal end, not unlike an Archimedes screw. It is a single use over-tube which connects with the enteroscope by means of a gentle locking mechanism. Clockwise rotation of the over-tube turns the spiral pleating the small bowel over the tube. This facilitates deep insertion of the enteroscope into the small bowel. Methods: We describe our experience of 21 patients undergoing spiral enteroscopy. These patients required small bowel investigation for a variety of indications including anaemia, obscure gastrointestinal bleeding and angiodyspalsia. The majority of procedures were performed on a day-case basis with same day discharge, the two exceptions were performed under general anaesthetic on the intensive care unit. An Endoease Endoluminal Advancement System (Spirus) was used in combination with a Fujinon enteroscope. Procedure duration and depth of insertion were recorded. Pathological findings and endoscopic therapy given were recorded. Patient toleration of the procedure was assessed and any immediate complications were recorded. Results: A total of 22 procedures were performed. 19 via the oral route and three via the anal route. The mean age of the patients was 67.1 years. The mean dosages of sedation used was Pethidine 48.75 mg and Midazolam 7.33 mg. The mean duration of procedure was 44.6 min and mean depth of insertion was 200 cm. In one patient a complete examination of the small bowel to the ileo-caecal valve was achieved. Significant pathology was identified in 11 cases and endoscopic therapy was applied in 10. The procedure was well tolerated in 73% of cases and no major complications were seen. Conclusion: Our initial experience of spiral enteroscopy has shown that it is an effective method for achieving deep intubation of the small bowel via both the oral and anal routes. The procedure is generally well-tolerated with conscious sedation and appears to be more time-efficient than DBE. In our series the procedure appears safe, with no major complications seen and no evidence of small bowel mucosal trauma.