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Use of spiral enteroscopy in a tertiary endoscopy center: initial experience.

In their article “The spiral enteroscopy training initiative: results of a prospective study evaluating the Discovery SB overtube device during small bowel enteroscopy,” Buscaglia et al. reported their experience of this new technique during a 2-day training module. The device is described as easy to use and able to be effectively operated after as few as five training cases [1]. We used this device during three different sessions with Daniel Cantero and we performed four enteroscopies under supervision; the fifth enteroscopy was performed without supervision. A total of five procedures were successfully performed in patients with obscure gastrointestinal bleeding (3 patients) and suspected inflammatory bowel disease (2 patients). Each procedure was performed with the patient under general anesthesia, and an Olympus SIF-160 Y enteroscope was used in all cases. In our experience as skilled endoscopists with extensive experience of single-balloon enteroscopy [2], we believe that five examinations are not enough to obtain deep enteroscope insertion beyond the ligament of Treitz, using the spiral technique. In our experience the median time to maximal enteroscope insertion was 60 minutes at the beginning. We believe that this device is not that easy to use; in particular the Cantero maneuver [3], as passing beyond the ligament of Treitz, is quite difficult to perform. We used the supine position and did not find additional difficulties, even though spiral enteroscopy is generally performed with the patient in the left supine position. On the other hand, the score for trauma through the pylorus and ligament of Treitz was 2 in the 4 practice cases under supervision and 0 in the case we performed without supervision (no mucosal edema and/or erythema was recorded). No other complications were reported. Furthermore, we believe that the operative procedures were easier to perform with the spiral technique than during single-balloon enteroscopy because the system (enteroscope plus spiral overtube) seems more stable than the other pushand-pull systems. In conclusion, we believe that spiral enteroscopy is a new device that seems to be promising and effective, but spiral technique is not easy for endoscopists who have extensive experience of balloon-assisted enteroscopy but no previous experience of this device. There seems to be a great advantage linked to the system’s higher stability. In addition, international data show the safety of this technique [3]. In general, balloon-assisted enteroscopies are lengthy, and our limited experience with this device does not so far confirm a shorter duration of the procedure when performed with the spiral overtube device.