Is Motorized Spiral Enteroscopy All That It Is Cut Out To Be?

In 2016, motorized spiral enteroscopy (mSe) was introduced to facilitate visualization for diagnosis and therapy of the small bowel. The primary aim of this review and meta-analysis was to evaluate the performance of mSe in diagnosing small bowel lesions (primary outcome). The secondary outcomes included therapeutic success, the total rate for enteroscopy (an examination from the duodenojejunal flexion to the cecum), technical success (passage from the ligament of Treitz or ileocecal valve for anterograde and retrograde approach), and complication rates. 

Researchers performed a systematic search in the Medline and Cochrane databases through September 2022 and then a meta-analysis using a random effects model, with results reported as percentages with 95% confidence intervals (CIs). The meta-analysis included 9 studies with a total of 959 patients (42% females) who underwent mSe for mid-GI bleeding/anemia. 

The diagnostic success rate of mSE was 78% (95% CI, 72-84; I2=78.3%). Total enteroscopy was attempted in 460 cases and completed in 51% (95% CI, 30-72; I2=96.2%). Therapeutic interventions were successful in 98% of attempted cases (95% CI, 96-100; I2=79.8%). Technical success rates were 96% (95% CI, 94-97; I2=1.5%) for anterograde and 97% (95% CI, 94-100; I2=38.6%) for retrograde approaches. The complication rate was 17% (95% CI, 13-21; I2=65.1%), with the majority representing minor adverse events (16% [95% CI, 11-20; I2=67.2%]) versus major adverse events (1% [95% CI, 0-1; I2=0%]).