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Abstract
Background and Aims
The introduction of motorized spiral enteroscopy (mSe) into clinical practice holds
diagnostic and therapeutic potential for small bowel investigation. This systematic
review with meta-analysis aims to evaluate the performance of this modality in diagnosing
and treating small bowel lesions.
Methods
A systematic search in Medline and Cochrane databases were performed through September
2022. The primary outcome was diagnostic success, defined as the identification of
a lesion relative to the indication. Secondary outcomes included successful therapeutic
manipulations, total enteroscopy rate (examination from the duodenojejunal flexion
to the cecum), technical success (passage from the ligament of Treitz or ileocecal
valve for anterograde and retrograde approach, respectively) and complication rates.
We performed meta-analyses using a random effects model and the results were reported
as percentages with 95% Confidence Intervals (95%CIs).
Results
From 2016 to 2022 nine studies [959 patients; 42% females; mean age>45 years; 474
(49.4%) investigated for mid GI bleeding/anemia) were considered eligible and included
in analysis. The diagnostic success rate of mSE was 78% (95%CI:72-84; I2=78.3%). Considering secondary outcomes, total enteroscopy was attempted in 460 cases,
and completed with a rate of 51% (95%CI:30-72; I2=96.2%), whereas therapeutic interventions were successful in 98% (95%CI:96-100; I2=79.8%) of cases where attempted. Technical success rates were 96% (95%CI:94-97; I2=1.5%) for anterograde and 97% (95%CI:94-100; I2=38.6%) for retrograde approaches, respectively. Finally, the incidence of complications
was 17% (95%CI:13-21; I2=65.1%), albeit the vast majority included minor adverse events [16% (95%CI: 11-20;
I2=67.2%) vs major= 1% (95%CI:0-1; I2=0%)].
Conclusions
Motorized spiral enteroscopy provides high rates of diagnostic and therapeutic success
with a low prevalence of severe adverse events.
Keywords
Abbreviationslist:
CI (confidence intervals), DAE (device-assisted enteroscopy), DBE (double balloon enteroscopy), ERCP (endoscopic retrograde cholangio-pancreatography), GI (gastrointestinal), NHLBI (National Heart, Lung, and Blood Institute), mSE (motorized spiral enteroscopy), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), RCTs (randomized controlled trials), SBE (single balloon enteroscopy), SE (spiral endoscopy), VCE (video capsule endoscopy)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
January 28,
2023
Received in revised form:
December 11,
2022
Received:
October 16,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflicts of interest: Marianna Arvanitakis received lecture fees by Olympus and Fujifilm.
Identification
Copyright
© 2023 by the American Society for Gastrointestinal Endoscopy
