The Evolution of Device-Assisted Enteroscopy: From Sonde Enteroscopy to Motorized Spiral Enteroscopy

The introduction of capsule endoscopy in 2001 opened the last “black box” of the gastrointestinal tract enabling complete visualization of the small bowel. Since then, numerous new developments in the field of deep enteroscopy have emerged expanding the diagnostic and therapeutic armamentarium against small bowel diseases. The ability to achieve total enteroscopy and visualize the entire small bowel remains the holy grail in enteroscopy. Our journey in the small bowel started historically with sonde type enteroscopy and ropeway enteroscopy. Currently, double-balloon enteroscopy, single-balloon enteroscopy, and spiral enteroscopy are available in clinical practice. Recently, a novel motorized enteroscope has been described with the potential to shorten procedure time and allow for total enteroscopy in one session. In this review, we will present an overview of the currently available techniques, indications, diagnostic yield, and complications of device-assisted enteroscopy.

Endoscopic Ultrasound Miniprobe and Single Balloon Enteroscopy: A Diagnostic Tool for Investigating Small Bowel Lesions

Objectives: The set of balloon-assisted enteroscopy and endoscopic ultrasonography (EUS) together can further improve the diagnosis of small bowel submucosal lesions. We reported our experience on clinical utility of the EUS miniprobe UM-3Y in the investigation of lesions of small bowel during single balloon enteroscopy (SBE). Methods: Between 2014 and 2017 we investigated 14 consecutive patients with symptoms, the suspect of small bowel tumor or inflammatory bowel disease. Almost all patients underwent video-capsule endoscopy before SBE. Results: EUS permitted us to better characterize lesions detected with SBE procedure with no complications and it permitted to exclude the presence of lesions in some doubtful cases.Conclusions: Our data demonstrated that EUS with miniprobe UM-3Y, associated with SBE, is an important diagnostic tool for investigating, with high accuracy, small bowel lesions. This can let to establish a better management of small bowel lesions.

Multiple Intestinal Lymphangiomas with Episodic Hemorrhage Requiring Partial Laparoscopic Resection: A Case Report

Background:Lymphangioma is a non-epithelial tumor marked by aggregates of abnormally dilated lymphatics. Mesenteric occurrences account for <1% of all cases, and <0.05% involve the gastrointestinal tract. Most are confined to children, rarely affecting adults. Case presentation:Herein, we describe an elderly Japanese woman with anemia, hypoalbuminemia, and episodic bleeding due to multiple intestinal lymphangiomas. Abdominal computed tomography revealed multiple low-density defects of mesentery, with areas of intermediate (T1 images) or high (T2 images) signal intensity similarly dispersed in magnetic resonance scanning sequences. Single-balloon enteroscopy was undertaken, enabling identification and tattooing of a small intestinal bleeding source. Laparoscopy-assisted resection at this site served to control related hemorrhage, removing a histologically confirmed hemolymphangioma. Having recovered uneventfully, the patient remained stable 2 months postoperatively. Conclusions:Although rare in adults, mesenteric or gastrointestinal lymphangiomas must be considered in a setting of anemia and hypoalbuminemia. Complete resection is advantageous to improve patient symptoms, but limited resection of multiple lesions may be equally effective.

Endoscopic therapy of small bowel polyps by single balloon enteroscopy in patients with Peutz-Jeghers syndrome

Background: Little is known about the efficacy and safety of single balloon enteroscopy (SBE) in patients with Peutz-Jeghers syndrome (PJS). The aim of this study was to assess the efficacy and safety of SBE for treatment of small bowel polyps in patients with PJS. Methods: We conducted a single center observational study, which included all patients diagnosed with PJS who underwent SBE for polypectomy between January 2018 and March 2021. Complete treatment was defined as the absence of polyps≥20mm after SBE resection. The clinical records were retrospectively reviewed. Results: 102 patients (including 40 men and 62 women) with a mean age of 28.7 years (range 13-55y), were enrolled in our study. The intubation depth via oral approach of patients with history of laparotomy was significantly shorter than that of the patients without history of laparotomy ([241.6±64.2] cm vs [280.9±40.2] cm, P = 0.008). The maximum size of the resected polyps via anus during the second hospitalization was significantly smaller than that during the first hospitalization ([2.25±1.29] cm vs [4.26±3.51] cm, P = 0.032). Complications occurred in 10/129 of hospitalizations (4 delayed bleeding, 3 perforation, and 3 acute pancreatitis). Conclusions: SBE is effective and safe for resection of small bowel polyps in patients with PJS.