Volume 86 - 2023 - Fasc.2 - Original articles
Motorized spiral enteroscopy: effectiveness when used for new indications
AbstractBackground and study aims: Motorized spiral enteroscopy is proven to be effective in antegrade and retrograde enteroscopy. Nevertheless, little is known about its use in less common indications. The aim of this study was to identify new indications for the motorized spiral enteroscope.Methods: Monocentric retrospective analysis of 115 patients who underwent enteroscopy using PSF-1 motorized spiral enteroscope between January 2020 and December 2022.Results: A total of 115 patients underwent PSF-1 enteroscopy. 44 (38%) were antegrade procedures and 24 (21%) were retrograde procedures in patients with normal gastrointestinal anatomy with conventional enteroscopy indications. The remaining 47 (41%) patients underwent PSF-1 procedures for secondary less conventional indications: n=25 (22%) enteroscopy-assisted ERCP, n=8 (7%) endoscopy of the excluded stomach after Roux-en-Y gastric bypass, n=7 (6%) retrograde enteroscopy after previous incomplete conventional colonoscopy and n=7 (6%) antegrade pan-enteroscopy of the entire small bowel. In this group of secondary indications, technical success rate was significantly lower (72.5%) as compared to technical success rates in the conventional groups (98-100%, p<0.001 Chi-square). Minor adverse events occurred in 17/115 patients (15%), all treated conservatively (AGREE I and II). Conclusion: This study demonstrates the capabilities of PSF-1 motorized spiral enteroscope for secondary indications. PSF-1 is useful to complete colonoscopy in case of long redundant colon, to reach the excluded stomach after Roux-en-Y gastric bypass, to perform unidirectional pan-enteroscopy and to perform ERCP in patients with surgically altered anatomy. However, technical success rates are lower as compared to conventional antegrade and retrograde enteroscopy procedures, with only minor adverse events. (Acta gastroenterol. belg., 2023, 86, 269-275).Keywords: Motorized spiral enteroscopy, pan-enteroscopy, incomplete colonoscopy, altered anatomy, ERCP.IntroductionThe small intestine represents a unique challenge in gastrointestinal endoscopy. Over the past two decades, advancements in technology have enabled gradual progress in examining and performing therapeutic procedures within the small bowel (1). Video capsule endoscopy was the first tool used to screen the entire small bowel. Subsequently, balloon-assisted enteroscopes enabled therapeutic interventions, ushering in the era of the push-and-pull technique, with double-balloon enteroscopy in 2001, single-balloon enteroscopy in 2007, and spiral enteroscopy in 2008, which required manual torque motion of the spiral device (2).In 2019, a motorized version of the spiral enteroscope became available as the PowerSpiral motorized spiral enteroscope (PSF-1). The PSF-1 is a video-enteroscope that is motor-propelled and has axial view. It is combined with the PowerSpiral overtube, which has soft, spiral-shaped fins that allow for progression in the small bowel with a helix-like movement (Figure 1) (3). It was developed to overcome the limitations of other types of device-assisted enteroscopy, such as balloon-assisted enteroscopy. Early reports suggest that this new device allows deeper and even complete enteroscopy witha similar profile to previous enteroscope models with regards to safety and diagnostic and therapeutic rates (4-6). The conventional indications for enteroscopy are well-established for antegrade and retrograde enteroscopy (such as treating arteriovenous malformations, retrieving foreign bodies, performing intestinal polypectomy, placing a percutaneous jejunostomy, dilating strictures, and performing mucosal biopsies deep in the small bowel) (2). However, it is unknown whether the newly developed motorized spiral enteroscope can also be used for secondary, less common indications, such as incomplete conventional colonoscopy in case of long redundant colon or accessing the excluded gastrointestinal tract in surgically altered anatomy with
A retrospective analysis of the histology of resected polyps and colonoscopy quality parameters in Belgium
Background and aims: adenoma detection rate is a well known
quality parameter for colonoscopy. However recently other quality
parameters have emerged. We wanted to evaluate the histology
of the resected polyps, different quality indicators of colonoscopy
and post colonoscopy colorectal cancer (PCCRC) in Belgium and
analyzed data about colonoscopies performed between 2008-2015.
Methods: Reimbursement data on colorectal related medical
procedures from the Intermutualistic Agency were linked with data
on clinical and pathological staging of colorectal cancer and with
histologic data of resected polyps available at the Belgian Cancer
Registry over a period covering 8 years (2008-2015).
Results: 298,246 polyps were resected in 294,923 colonoscopies,
of which 275,182 were adenomas (92 %) and 13,616 were SSLs
(4%). There was a significant but small correlation between the
different quality parameters and PCCRC. Post colonoscopy
colorectal cancer rate after 3 years was 7.29 %. There were marked
geographic differences in Belgium concerning adenoma detection
rate, sessile adenoma detection rate and post colonoscopy colorectal
Conclusion: Most resected polyps were adenomas, only a small
percentage involved sessile serrated lesions. There was a significant
correlation between adenoma detection rate and other quality
parameters, and a small but significant correlation between
PCCRC and the different quality parameters. The lowest post
colonoscopy colorectal cancer rate was reached with an ADR of
31.4 % and a SSL-DR of 1.2 %.
Irritable bowel syndrome-like symptoms before and after bariatric surgery and association with short-chain fermentable carbohydrates consumption: an observational prospective study
Background and aims: Irritable Bowel Syndrome (IBS)-like symptoms are frequent following bariatric surgery. This study aims to evaluate the frequency of IBS symptoms severity before and after bariatric surgery and their association with short-chain fermentable carbohydrates (FODMAPs) consumption.
Patients and methods: IBS symptoms severity in a cohort of obese patients was evaluated prospectively before, 6 and 12 months after bariatric surgery by validated questionnaires and tools (Irritable Bowel Syndrome Severity Scoring System (IBS SSS), Bristol Stool Scale (BSS), Quality of Life Short- Form-12 (SF-12), Hospital Anxiety and Depression scale (HAD)). FODMAPs consumption and its association with IBS symptom severity was evaluated by using a food frequency questionnaire focused on high-FODMAPs food consumption.
Results: Fifty-one patients were included (41 female; mean age 41 years (SD: 12)), 84% received a sleeve gastrectomy, and 16% a Roux-en-Y gastric bypass. Symptoms compatible with IBS were observed in 43% of patients before surgery, in 58% of patients at 6 months and 33% at 12 months (NS, p-value=0,197 and 0,414). In a multivariate model, a significant association was found between the IBS SSS score and lactose consumption at 6 months (β = + 58, 1; p = 0.03), and with polyols consumption at 12 months (β = + 112,6; p = 0.01).
Conclusions: Mild to moderate IBS symptoms are frequent in obese patients before bariatric surgery. A significant association between lactose and polyols consumption and IBS SSS score was observed after bariatric surgery, suggesting a potential link between the severity of IBS symptoms and some specific FODMAPs consumption.
Association between barium exposure and non-alcoholic fatty liver disease in U.S. adults
Background and aims: There are very limited studies that have investigated the influence of environmental barium exposure on non-alcoholic fatty liver disease (NAFLD) in the general adult population. The purpose of the present paper was to examine any correlation between urinary barium levels (UBLs) and the risk of NAFLD.
Patients and methods: A total of 4,556 participants aged ≥ 20 years were recruited from the National Health and Nutritional Survey. NAFLD was defined as the U.S. fatty liver index (USFLI) ≥ 30 in the absence of other chronic liver disease. Multivariate logistic regression was conducted to inspect the correlation between UBLs and the risk of NAFLD.
Results: The outcome of adjusting covariates revealed a positive correlation between the natural log -transformed UBLs (Ln-UBLs) and the risk of NAFLD (OR: 1.24, 95%CI: 1.12-1.37, P<0.001). After dividing Ln-UBLs into quartiles, the participants in the highest quartile exhibited a 1.65-fold (95% CI: 1.26-2.15) increased likelihood of having NAFLD in contrast with the bottom quartile in the full model, and a distinct trend across the quartiles could be found (P for trend<0.001). Moreover, in the interaction analyses, it was further observed that the association between Ln-UBLs and NAFLD was modified by gender and was noticeably more pronounced in males (P for interaction =0.003).
Conclusions: Our findings provided evidence of a positive correlation between UBLs and the prevalence of NAFLD. Furthermore, this association changed across gender and was more pronounced in males. Nevertheless, our finding requires further confirmation with prospective cohort studies in the future.