Abstract
Spiral Endoscopy (SE) has recently been developed. Currently, SE has been performed in more than 10,000 patients all over the world. SE has two components, an endoscope and a rotating overtube with spiral protrusion at the tip of the overtube. The rotating overtube pleats the small intestine onto the proximal side of the overtube and makes it possible to access deeper into the small intestine. Akerman et al. reported that the overall severe complication rate was 0.3%. SE is technically feasible and safe even in elderly patients with numerous comorbidities. Some studies have compared SE with double balloon endoscopy (DBE) and showed that SE enabled insertion to similar depths in a significantly shorter time as compared with DBE. SE can be performed by a single endoscopist with an assistant who manipulates the overtube. The procedure is performed under conscious sedation with carbon dioxide instead of the air for insufflation. In order to achieve the deep insertion, “engagement”, which indicates that the spiral part of the rotating overtube properly grips the small intestine, is necessary. After the engagement, the engaging unit is advanced with clockwise rotation. When the scope is withdrawn, a counter clockwise rotation is required. So far, we have performed 31 SEs in 2 hospitals. Among them, we were able to diagnose 16 patients with small intestinal lesions using SE, including 6 malignant lymphomas, 3 erosions, 3 polyps, 2 angioectasias, 1 adenocarcinoma, and 1 submucosal tumor. Moreover, 4 patients underwent endoscopic interventions ; 2 hemostases and 2 polypectomies. The average insertion time was 26 minutes. Relatively high dose sedation was required during the procedure. Mallory Weiss syndrome occurred in 1 patient. Thirteen patients had mucosal injury during the procedure. No perforation occurred in any patient. SE can be introduced safely, but is relatively invasive and technically demanding. More experience is need to conduct SE easily and safely.
