Spiral enteroscopy is safe and effective for an elderly United States population of patients with numerous comorbidities.

Background & Aims: Preliminary studies performed outside of the United States demonstrated that spiral enteroscopy is safe and effective when performed in young, healthy patients. However, spiral enteroscopy has not been evaluated in a US population of patients with numerous comorbidities. We evaluated the feasibility, efficacy, and safety of spiral enteroscopy in a US population of older patients with multiple comorbidities and a high prevalence of pathologic findings.

Methods: We performed a prospective case series of 61 patients with clinical indications for deep enteroscopy conducted at 2 US academic tertiary referral centers. Patients underwent deep enteroscopy with the spiral Endo-Ease Discovery SB overtube. Insertion depth, procedure time, diagnostic findings, therapeutic maneuvers, sedation type, and complications were recorded.

Results: Spiral enteroscopy was attempted in 61 patients (mean age, 65.4 +/- 12.4 years); 52% were rated by American Society of Anesthesiologists guidelines as class 3 (n = 30) or 4 (n = 2). The procedure was successfully completed in 56 of 61 patients (92%). Average insertion depth was 217.4 +/- 79 cm beyond the ligament of Treitz. The total mean procedure time was 41 +/- 15 minutes (diagnostic time, 36 +/- 12 minutes; therapy time, 5 +/- 9 minutes). Positive findings were noted in 36 cases (59%), with therapeutic maneuvers performed in 30 cases (49%). A total of 41 cases (67%) were performed under conscious sedation; fluoroscopy was not used in any case. Four mild complications occurred, and there were no perforations.

Conclusions: Spiral enteroscopy is technically feasible and safe in an elderly US population of patients with numerous comorbidities.