Editorial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2024; 30(26): 3185-3192
Published online Jul 14, 2024. doi: 10.3748/wjg.v30.i26.3185
Device-assisted enteroscopy: Are we ready to dismiss the spiral?
Alessandro Mussetto, Elettra Merola, Cesare Casadei, Daniele Salvi, Fabiola Fornaroli, Silvia Cocca, Margherita Trebbi, Armando Gabbrielli, Cristiano Spada, Andrea Michielan
Alessandro Mussetto, Cesare Casadei, Margherita Trebbi, Department of Gastroenterology, S Maria della Croci Hosp, Ravenna 48121, Italy
Elettra Merola, Department of Gastroenterology Unit, G.B. Grassi Hospital (ASL Roma 3), Roma 00122, Italy
Daniele Salvi, Section of Digestive Endoscopy and Gastroenterology, Fondazione Poliambulanza, Brescia 25124, Italy
Fabiola Fornaroli, Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma 43125, Italy
Silvia Cocca, Gastroenterology and Endoscopy Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena 41121, Italy
Armando Gabbrielli, Center for Medical Sciences (CISMed), University of Trento, Trento 38122, Italy
Armando Gabbrielli, Andrea Michielan, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari, Trento 38122, Italy
Cristiano Spada, Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma 00168, Italy
Author contributions: Mussetto A and Michielan A designed the research; Trebbi M, Salvi D, Fornaroli F and Cocca S performed the research; Merola E, Casadei C, Gabbrielli A and Spada C analyzed the data; Mussetto A, Michielan A, Trebbi M, Salvi D, Fornaroli F and Cocca S drafted the manuscript; Merola E, Gabbrielli A and Spada C critically revised the manuscript for important intellectual content; Michielan A supervised the study. All authors have read and approved the final manuscript.
Conflict-of-interest statement: All authors declare no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Andrea Michielan, MD, Doctor, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Azienda Provinciale per i Sevizi Sanitari, Largo Medaglie d’oro 9, Trento 38122, Italy. andrea.michielan@apss.tn.it
Received: January 19, 2024
Revised: May 27, 2024
Accepted: June 19, 2024
Published online: July 14, 2024
Processing time: 172 Days and 1.4 Hours
Abstract

Motorized spiral enteroscopy (MSE) is the latest advance in device-assisted enteroscopy. Adverse events related to MSE were discussed in a recent large systematic review and meta-analysis and were directly compared with those of balloon enteroscopy in a case-matched study and a randomized controlled trial. Following the real-life application of MSE, an unexpected safety issue emerged regarding esophageal injury and the technique has been withdrawn from the global market, despite encouraging results in terms of diagnostic and therapeutic yield. We conducted an Italian multicenter real-life prospective study, which was prematurely terminated after the withdrawal of MSE from the market. The primary goals were the evaluation of MSE performance (both diagnostic and therapeutic) and its safety in routine endoscopic practice, particularly in the early phase of introduction in the endoscopic unit. A subanalysis, which involved patients who underwent MSE after unsuccessful balloon enteroscopy, demonstrated, for the first time, the promising performance of MSE as a rescue procedure. Given its remarkable performance in clinical practice and its potential role as a backup technique following a previously failed enteroscopy, it may be more appropriate to refine and enhance MSE in the future rather than completely abandoning it.

Keywords: Motorized spiral enteroscopy; Rescue enteroscopy; Diagnostic yield; Adverse events; AGREE classification

Core Tip: In July 2023, motorized spiral enteroscopy (MSE) was withdrawn from the global market, accompanied by an urgent safety notification. Our multicenter real-life prospective study, although prematurely interrupted, demonstrated the promising performance of MSE as a rescue procedure after a previously failed balloon enteroscopy. After a literature review about the safety of MSE, we propose that the technique should not be completely discarded but instead refined due to its very high diagnostic and therapeutic yield and its potential role as a backup enteroscopy.