Majeed AA, Butt AS. Motorized spiral enteroscopy in altered anatomy: Balancing clinical success with safety challenges. World J Gastrointest Endosc 2025; 17(11): 113466 [PMID: 41256301 DOI: 10.4253/wjge.v17.i11.113466]
Corresponding Author of This Article
Amna S Butt, Associate Professor, Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi 74800, Pakistan. amna.subhan@aku.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Nov 16, 2025; 17(11): 113466 Published online Nov 16, 2025. doi: 10.4253/wjge.v17.i11.113466
Motorized spiral enteroscopy in altered anatomy: Balancing clinical success with safety challenges
Ammara Abdul Majeed, Amna S Butt
Ammara Abdul Majeed, Amna S Butt, Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
Author contributions: Majeed AA and Butt AS both had reviewed the article, performed literature search and written the letter to the editor.
Conflict-of-interest statement: All authors have no conflict of interest to disclose.
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: Amna S Butt, Associate Professor, Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi 74800, Pakistan. amna.subhan@aku.edu
Received: August 26, 2025 Revised: September 14, 2025 Accepted: October 15, 2025 Published online: November 16, 2025 Processing time: 80 Days and 10.7 Hours
Abstract
Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y-anatomy is technically challenging and additional techniques including balloon-assisted enteroscopy, endoscopic ultrasound (EUS) guided, and percutaneous approaches offers only modest success rates. Motorized spiral enteroscopy (MSE)-assisted ERCP (MSE-ERCP) has emerged as a potential alternative. In a retrospective study by Nennstiel et al, MSE-ERCP achieved high success rates for biliary entry (88%) and therapeutic intervention (83%). However, outcomes varied significantly between bilioenteric anastomosis (93%) and native papilla (63%), underscoring the importance of anatomy-driven procedural selection. Despite encouraging efficacy, the global withdrawal of the MSE platform due to serious device-related complications highlights the ongoing balance between feasibility and safety. Future directions should prioritize refinements in device engineering, multicenter prospective trials comparing MSE with balloon-assisted and EUS-guided techniques, and systematic outcome stratification by anatomical subgroup. Such efforts will be critical to defining the role of MSE within the therapeutic algorithm for surgically altered anatomy.
Core Tip: Endoscopic retrograde cholangiopancreatography in Roux-en-Y anatomy remains technically challenging, with higher success through bilioenteric anastomosis than the native papilla. Emerging strategies including balloon-assisted enteroscopy, motorized spiral enteroscopy (MSE) and endoscopic ultrasound-guided drainage highlight the need for personalized procedural selection based on anatomy, clinical scenario, and institutional expertise. MSE offers high diagnostic and therapeutic potential but requires further refinement to address safety concerns before wider adoption.
