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

Abstract

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.

Keywords: deep enteroscopy; device-assisted enteroscopy; double-balloon enteroscopy (DBE); motorized enteroscopy; small bowel; spiral enteroscopy.

Figure 1

68-year-old male presented with melenic stools and a hemoglobin of 5.5 g/dL. Upper endoscopy and colonoscopy did not reveal the source of bleeding. Video capsule endoscopy revealed multiple proximal small bowel angioectasia (A). Antegrade double balloon enteroscopy was performed with successful ablation of angioectasia using argon plasma coagulation (B). Bleeding submucosal arteriovenous malformations (AVMs) found on deep enteroscopy requiring surgical resection (C,D).

Figure 2

Small bowel tumors and polyps found on deep enteroscopy: well differentiated neuroendocrine tumors in the ileum (A–C), moderately differentiated invasive adenocarcinoma in the jejunum (D), tubulovillous adenoma with low-grade dysplasia (E), small bowel metastasis secondary to renal cell carcinoma (F).

Figure 3

Device-assisted enteroscopy in the setting of stricturing small bowel Crohn's disease. A 70-year-old male with history of small bowel Crohn's disease on Infliximab was referred for deep enteroscopy after a small bowel follow through showed a stricture in the distal jejunum. Antegrade double balloon enteroscopy showed severe stenosis with friability and ulcerations (A,B). Biopsies showed chronic enteritis with moderate activity. Biologic therapy for his Crohn's disease was adjusted accordingly. A 24-year-old male with small bowel Crohn's disease was referred for deep enteroscopy after retention of video capsule endoscopy in the small bowel. Retrograde double-balloon enteroscopy showed the capsule at the level of an ileal stricture (C). The stricture was dilated using through-the-scope balloon dilation (D).

Figure 4

A 60-year-old female with a history of Roux-en-Y gastric bypass and persistent abdominal pain despite extensive work-up was referred for deep enteroscopy for evaluation of the gastric remnant. Antegrade double-balloon enteroscopy was performed showing the jejuno-jejunal anastomosis (A), the major papilla (B), the pylorus (C), and the excluded stomach (D).