Technical performance and diagnostic yield of motorised spiral enteroscopy compared with single-balloon enteroscopy in suspected Crohn's disease: a randomised controlled, open-label study (the MOTOR-CD trial).

Autor:	Pal P; Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India partha0123456789@gmail.com., Ramchandani M; Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India., Banerjee R; Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India., Viswakarma P; Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India., Singh AP; Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India., Reddy M; Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India., Rughwani H; Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India., Patel R; Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India., Sekaran A; Department of Pathology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India., Kanaganti S; Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India., Darisetty S; Department of Aneasthesiology, Asian Institute of Gastroenterology, Hyderabad, India., Nabi Z; Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India., Singh J; Department of Interventional Radiology, Asian Institute of Gastroenterology, Hyderabad, India., Gupta R; Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India., Lakhtakia S; Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India., Pradeep R; Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India., Venkat Rao G; Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India., Tandan M; Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India., Reddy DN; Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
Jazyk:	angličtina
Zdroj:	Gut [Gut] 2023 Oct; Vol. 72 (10), pp. 1866-1874. Date of Electronic Publication: 2023 May 17.
DOI:	10.1136/gutjnl-2023-329885
Abstrakt:	Objective: Recent studies have shown that motorised spiral enteroscopy (MSE) enables deeper and total small bowel evaluation compared with single-balloon enteroscopy (SBE) in suspected Crohn's disease (CD) when analysed per procedure. However, no randomised controlled study has compared bidirectional MSE with bidirectional SBE in suspected CD. Design: Patients with suspected CD requiring small bowel enteroscopy were randomly assigned to either SBE or MSE between May 2022 and September 2022 in a high volume tertiary centre. Bidirectional enteroscopy was done if intended lesion could not be reached on unidirectional study. Comparison was made with regard to technical success (ability to reach lesion), diagnostic yield, depth of maximal insertion (DMI), procedure time and total enteroscopy rates. Depth:time ratio was calculated to avoid confounding for the location of lesion. Results: Among 125 suspected patients with CD (28% female, 18-65 years, median 41 years), 62 and 63 underwent MSE and SBE, respectively. The overall technical success (98.4 %: MSE, 90.5 %: SBE; p=0.11), diagnostic yield (95.2%: MSE; 87.3%: SBE, p=0.2) and procedure time were not significantly different. However, MSE appeared to have higher technical success (96.8% vs 80.7%, p=0.08) in deeper small bowel (distal jejunum/proximal ileum) with higher DMI, higher depth:time ratio and total enteroscopy rates when attempted (77.8% vs 11.1%, p=0.0007). Both the modalities were safe although minor adverse events were more common with MSE. Conclusion: MSE and SBE have comparable technical success and diagnostic yield for small bowel evaluation in suspected CD. MSE scores over SBE with regard to deeper small bowel evaluation with complete small bowel coverage and higher depth of insertion in a shorter time. Trial Registration Number: NCT05363930. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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