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.

A novel paclitaxel coated balloon with increased drug transfer for treatment of complex vascular lesions

Background Drug coated balloons (DCB) with paclitaxel (Ptx) dose of 2–3.5 μg/mm2 balloon surface inhibit restenosis with different effectiveness and duration of success. A clinical dose finding study is not known for any of the currently marketed products. The aim of the present preclinical trial was to investigate a novel DCB coated with 6 μg Ptx/mm2 in a porcine model. Methods and results The current study investigated a DCB with a novel, modified iopromide based matrix with 6 μg Ptx/mm2. Drug transfer to the vessel wall of peripheral arteries was compared with a dose of 3 μg Ptx/mm2 and two fully overlapping DCB with 3 μg Ptx/mm2, each. Ptx concentration in the vessel wall after drug transfer was about twice as high for balloons with 6 μg/mm2 (1957±1472 μg/g) and two overlapping DCB with 3 μg Ptx/mm2, each (1287±619 μg/g) compared to a single balloon with 3 μg Ptx/mm2, (787±738 μg/g), with statistical significant differences for 1x6 μg/mm2 vs. 1x3 μg/mm2 (p = 0.017) but not for 2x3 μg/mm2 vs. 1x3 μg/mm2 (p = 0.184) and 1x6 μg/mm2 vs. 2x3 μg/mm2 (p = 0.178). The proportion of residual Ptx on balloon after treatment was similar for all groups between 6±1% and 10±3% of dose on balloon. Conclusion The dose of 6 μg Ptx/mm2 was successfully as well as reproducibly coated on conventional balloon catheters. Increased Ptx on balloons resulted in increased drug concentration in the vessel wall. A single balloon with 6 μg Ptx/mm2 seems to provide double dose compared to 3 μg Ptx/mm2, facilitates the procedure, and may reduce medico-economic cost compared to the use of two standard DCB.

Endovascular Treatment of Acute MI Occlusions Due To Underlying Intracranial Atherosclerotic Severe Stenosis

Objective: Endovascular treatment (EVT) for acute ischemic stroke with an occlusion of the M1 segment due to intracranial atherosclerotic severe stenosis (ICASS) remains challenging. This study aimed to evaluate the safety and efficacy of EVT for ICASS-related M1 acute occlusion.Methods: We retrospectively reviewed all patients with an ICASS-related M1 acute occlusion underwent EVT at our institution between January 2015 and December 2020. Clinical presentation, baseline characteristics, angiographic and clinical results, technical feasibility, perioperative complications, and follow-up results were evaluated.Results: Twenty-two patients with ICASS-related M1 acute occlusion were included. Eight patients (36.4%) received bridging therapy and the other 14 patients (63.6%) directly underwent EVT. Fifteen patients (68.2%) treated with balloon dilations and stenting as rescue treatment. Six patients (27.3%) received single balloon angioplasty and 5 of these patients treated with staged stenting. One case (4.5%) failed recanalization at the first EVT and successful revascularization was achieved a month later. The mean procedure time was 67.2±20.8 min. Successful revascularization (mTICI≥2b) was achieved in 95.5% (21/22) of patients. Perioperative complications developed in two patients (9.1%) including one hemorrhagic event and one thromboembolic event. Anangiographic follow-up was available in 20 patients (90.9%) at an average of 8.6±3.0 months. The degree of stenosis was worse (10%-30%) in 6 cases (30%) compared with the initial outcomes. The favorable outcomes (mRS≤2) at 3 months follow-up was achieved in 19 patients (86.4%).Conclusions: ICASS-related occlusion in the M1 segment often required a rescue therapy including balloon angioplasty with/without stenting, and this treatment strategy was safe and effective. But single balloon angioplasty at the first EVT generally cannot achieve satisfactory results and often needed staged stenting treatment.

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.