Motorized Spiral Enteroscopy: to infinity and beyond?

With the advent of device-assisted enteroscopy (DAE) in the early 2000s, endoscopic access to the entire small bowel is possible nowadays (1). And yet, there is still room for improvement. Total enteroscopy remains a time-consuming procedure, often combining the antegrade (oral) and retrograde (anal) approach with only a reasonable chance to obtain complete endoscopy of the entire small bowel (2). Therefore, the aim is to go faster, deeper and to perform more advanced therapeutic interventions within the long and tortuous small bowel. Moreover, DAE was also shown to be effective to perform endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy and to complete colonoscopy in patients with previously incomplete conventional colonoscopy due to long dolichocolon (3). The latest DAE development is Motorized Spiral Enteroscopy (MSE), initially conceptualized as a manually driven rotational spiral overtube by Paul A. Akerman, and further developed and commercialized as a motorized spiral overtube by the Olympus Medical Systems Corporation (4). Initial feasibility trials have shown that MSE can compete with already available DAE techniques (single- and double-balloon enteroscopy) with regard to diagnostic yield and endotherapy within the small bowel (5,6). However, being a short type enteroscope of 168 cm (as compared to the 200 cm long single- and double-balloon enteroscopes), MSE appears to be even more effective in obtaining deep and total enteroscopy with a relatively short procedural duration (2,6). In addition, the working channel diameter is increased to 3.2 mm (as compared to 2.8 mm) with an extra irrigation channel, facilitating therapeutic interventions within the small bowel. This faster and deeper (but more aggressive) enteroscopy technique comes with the price of an increased risk of mucosal injuries (ranging from superficial bruising to laceration and even perforation) within the oesophagus and the small bowel, luckily remaining asymptomatic most of the time without any clinical consequence (6). So far, this promising new technique has the potential of becoming a gamechanger in the still evolving field of deep enteroscopy.