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World J Gastroenterol. Jul 21, 2019; 25(27): 3538-3545
Published online Jul 21, 2019. doi: 10.3748/wjg.v25.i27.3538
Device-assisted enteroscopy: A review of available techniques and upcoming new technologies
Markus Schneider, Jörg Höllerich, Torsten Beyna
Markus Schneider, Jörg Höllerich, Torsten Beyna, Department of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf 40217, Germany
Author contributions: Schneider M, Höllerich J and Beyna T wrote the review.
Conflict-of-interest statement: Schneider M and Höllerich J have nothing to disclose; Beyna T reports personal fees from Olympus, personal fees from Medronic, personal fees from Falk, personal fees from Cook, personal fees from Boston Scientific, during the conduct of the study.
Open-Access: This article is an open-access article which was selected byan in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Markus Schneider, MD, Academic Research, Senior Physician, Department of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Kirchfeldstrasse 40, Düsseldorf 40217, Germany. markus.schneider@evk-duesseldorf.de
Telephone: +49-211-9191605
Received: March 27, 2019
Peer-review started: March 28, 2019
First decision: April 16, 2019
Revised: May 1, 2019
Accepted: May 31, 2019
Article in press: June 1, 2019
Published online: July 21, 2019
Processing time: 114 Days and 17.6 Hours
Abstract

The advent of video capsule endoscopy into clinical routine more than 15 years ago led to a substantial change in the diagnostic approach to patients with suspected small bowel diseases, often indicating a deep enteroscopy procedure for diagnostical confirmation or endoscopic treatment. Device assisted enteroscopy was developed in 2001 and for the first time established a practicable, safe and effective method for evaluation of the small bowel. Currently with double-balloon enteroscopy, single-balloon enteroscopy and spiral enteroscopy three different platforms are available in clinical routine. Summarizing, double-balloon enteroscopy seems to offer the deepest insertion depth to the small bowel going hand in hand with the disadvantage of a longer procedural duration. Manual spiral enteroscopy seems to be a faster procedure but without reaching the depth of the DBE in currently available data. Finally, single-balloon enteroscopy seems to be the least complicated procedure to perform. Despite substantial improvements in the field of direct enteroscopy, even nowadays deep endoscopic access to the small bowel with all available methods is still a complex procedure, cumbersome and time-consuming and requires high endoscopic skills. This review will give an overview of the currently available techniques and will further discuss the role of the upcoming new technology of the motorized spiral enteroscopy (PowerSpiral).

Keywords: Small bowel disease; Capsule endoscopy; Enteroscopy; PowerSpiral enteroscopy; Endoscopy

Core tip: This review will give an overview of the currently available techniques especially the double balloon-enteroscopy, the single balloon-enteroscopy and the manual spiral enteroscopy. Further the role of the upcoming new technology of the PowerSpiral will be discussed. Available preliminary data on novel PowerSpiral Enteroscopy promise a safe and effective tool for deep enteroscopy with a possible faster, deeper and less invasive approach. Further careful evaluation in larger prospective randomized clinical trials is needed to determine the further role of PSE in diagnostic and therapeutic approach to the small bowel.