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  • 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)

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Endoscopy
Original research
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)
  1. Partha Pal1,
  2. Mohan Ramchandani1,
  3. Rupa Banerjee1,
  4. Piyush Viswakarma1,
  5. Aniruddha Pratap Singh1,
  6. Manohar Reddy1,
  7. Hardik Rughwani1,
  8. Rajendra Patel1,
  9. Anuradha Sekaran2,
  10. Swathi Kanaganti1,
  11. Santosh Darisetty3,
  12. Zaheer Nabi1,
  13. Jagadish Singh4,
  14. Rajesh Gupta1,
  15. Sundeep Lakhtakia1,
  16. Rebala Pradeep5,
  17. G Venkat Rao5,
  18. Manu Tandan1,
  19. D Nageshwar Reddy1
  1. 1 Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
  2. 2 Department of Pathology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
  3. 3 Department of Aneasthesiology, Asian Institute of Gastroenterology, Hyderabad, India
  4. 4 Department of Interventional Radiology, Asian Institute of Gastroenterology, Hyderabad, India
  5. 5 Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
  1. Correspondence to Dr Partha Pal, Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India; partha0123456789{at}gmail.com

Abstract

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.

  • crohn's disease
  • enteroscopy
  • inflammatory bowel disease
  • small bowel enteroscopy

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

https://doi.org/10.1136/gutjnl-2023-329885

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as online supplemental information.

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    Footnotes

    • Twitter @ibd_pal, @drmohanjr, @DrRupaBanerjee1, @Piyush6888, @MDinternalmed, @drhrr, @gut_rp, @AnuradhaSekara1, @ZaheerNabi8

    • Contributors Guarantor: PP; Conceptualisation: PP, MoR, MT and DNR; Investigation: PP, MoR, RB, APS, HR, MaR, RaP, PV, ZN, RG, SL, ReP, GVR, MT and DNR; Acquisition of data: APS, PV, HR, PP, MaR, RaP, SK and AS; Analysis and interpretation of data: PP, PV, MT; Methodology: RB, PP, MT, MR, APS, MaR, HR, RaP, SK, SD, ZN, JS, RG, SL and ReP; Drafting of manuscript: PP, PV, MT and RB, Revision of the manuscript: MT, MR, RB, APS, HR, MaR, RaP, AS, SD, ZN, SK, SL, JS, RG, ReP, GVR and DNR; Statistical analysis: PP, PV and SK; Administrative support: DNR, MT, RB, RG, SL and GVR, Resources: DNR, MT and GVR; Study supervision: PP, RB and MR, Approval of final ver-sion of manuscript: all.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.