title: Spiral Enteroscopy Utilizing Capsule Location Index for Achieving High Diagnostic and Therapeutic Yield.
abstract: Background and Aim. Spiral enteroscopy (SE) is a new small bowel endoscopic technique. Our aim is to review the diagnostic and therapeutic yield, safety of SE, and the predictive role of prior capsule endoscopy (CE) at an academic center. Methods. A retrospective review of patients undergoing SE after prior CE between 2008 and 2013 was performed. Capsule location index (CLI) was defined as the fraction of total small bowel transit time when the lesion was seen on CE. Results. A total of 174 SEs were performed: antegrade (147) and retrograde (27). Abnormalities on SE were detected in 65% patients. The procedure was safe in patients with surgically altered bowel anatomy (n = 12). The diagnostic yield of antegrade SE decreased with increasing CLI range. The diagnostic yield of retrograde SE decreased on decreasing CLI range. A CLI cutoff of 0.6 was derived that determined the initial route of SE. Vascular ectasias seen on CE were detected in 83% cases on SE; p < 0.01. Conclusions. SE is safe with a high diagnostic and therapeutic yield. CLI is predictive of the success of SE and determines the best route of SE. The type of small bowel pathology targeted by SE may affect its utility and yield.
authors.affiliation: Department of Medicine, Thomas Jefferson University Hospital, 132 S 10th Street, Philadelphia, PA 19107, USA.
authors.forename: Rohan
authors.identifier: 0000-0002-0749-9022
authors.initials: R
authors.lastname: Mandaliya
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University Hospital, 132 S 10th Street, Philadelphia, PA 19107, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Korenblit
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University Hospital, 132 S 10th Street, Philadelphia, PA 19107, USA.
authors.forename: Brendan
authors.initials: B
authors.lastname: O'Hare
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University Hospital, 132 S 10th Street, Philadelphia, PA 19107, USA.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Shnitser
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University Hospital, 132 S 10th Street, Philadelphia, PA 19107, USA.
authors.forename: Ramalinga
authors.initials: R
authors.lastname: Kedika
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University Hospital, 132 S 10th Street, Philadelphia, PA 19107, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Matro
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University Hospital, 132 S 10th Street, Philadelphia, PA 19107, USA.
authors.forename: Dina
authors.initials: D
authors.lastname: Halegoua-De Marzio
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University Hospital, 132 S 10th Street, Philadelphia, PA 19107, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Infantolino
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University Hospital, 132 S 10th Street, Philadelphia, PA 19107, USA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Conn