ABSTRACT Introduction With the global increase in life expectancy, there is an increase in gastrointestinal presentations in the elderly. Small bowel bleeding (SBB) is a cause of significant morbidity in the elderly requiring multiple hospital visits, investigations, and potentially expensive therapy. Areas covered In this review, we will outline the different modalities which are used for the diagnosis and management of SBB. We will also discuss the common causes of SBB in the elderly. Expert opinion SBB in elderly has a significant impact on the quality of life of the elderly. Larger randomized studies in the elderly are urgently required to help guide clinicians on the best and most cost-effective treatment algorithm in this challenging cohort.

https://www.tandfonline.com/doi/pdf/10.1080/17474124.2023.2214726?needAccess=true&role=button

Small bowel bleeding: clinical diagnosis and management in the elderly

Motorized spiral enteroscopy (MSE) is the latest advance in device-assisted enteroscopy. Adverse events related to MSE were discussed in a recent large systematic review and meta-analysis and were directly compared with those of balloon enteroscopy in a case-matched study and a randomized controlled trial. Following the real-life application of MSE, an unexpected safety issue emerged regarding esophageal injury and the technique has been withdrawn from the global market, despite encouraging results in terms of diagnostic and therapeutic yield. We conducted an Italian multicenter real-life prospective study, which was prematurely terminated after the withdrawal of MSE from the market. The primary goals were the evaluation of MSE performance (both diagnostic and therapeutic) and its safety in routine endoscopic practice, particularly in the early phase of introduction in the endoscopic unit. A subanalysis, which involved patients who underwent MSE after unsuccessful balloon enteroscopy, demonstrated, for the first time, the promising performance of MSE as a rescue procedure. Given its remarkable performance in clinical practice and its potential role as a backup technique following a previously failed enteroscopy, it may be more appropriate to refine and enhance MSE in the future rather than completely abandoning it. 

Device-assisted enteroscopy: Are we ready to dismiss the spiral?

Abstract Background and Aim: Double-balloon enteroscopy (DBE) is a well-established procedure for direct visualisation of the entire small bowel mucosa, and, in contrast with other imaging techniques, allows to perform biopsies and therapeutic interventions. The aim of this study was to evaluate the indications, diagnostic yield, therapeutic yield, and complications of DBE in a cohort of consecutive patients according to patients’ age. Methods: We conducted a retrospective study of consecutive patients who underwent DBE in our endoscopy unit between January 2006 and December 2021. Results: A total of 387 consecutive patients who underwent 460 DBE procedures were included. Mean age of the patients was 63 years. The overall diagnostic yield was 67.6%; vascular lesions were the predominant endoscopic findings (31.5%), followed by polyps or neoplastic masses (17.6%). Older patients (≥65 years) showed statistically higher rates of clinically relevant findings than adult patients (18–65 years) (p = 0.001). Crohn’s disease and polyps or neoplastic masses were more frequent in the younger group (p = 0.009 and p = 0.066, respectively), while vascular lesions and non-specific inflammation were the most common findings in the older group (p < 0.001 and p < 0.001, respectively). The therapeutic intervention rate was 31.7%. Rates of endoscopic treatment were significantly higher in the older group (p < 0.001). Total complications occurred in five procedures (1.1%). Conclusion: In clinical practice, DBE is an efficient diagnostic and therapeutic tool with a high safety profile, particularly in the elderly population.

/pdf/outcomes-of-double-balloon-enteroscopy-in-elderly-vs-adult-2edv0url.pdf

Outcomes of Double Balloon-Enteroscopy in Elderly vs. Adult Patients: A Retrospective 16-Year Single-Centre Study

Background/Aims: Double-headed capsule endoscopy enhances visualization and diagnostic yield in small bowel evaluation but increases reading time. This study aimed to assess the diagnostic performance of AI-assisted double-headed capsule endoscopy (MiroCam MC2000) across all small bowel indications and to compare its reading efficiency with the standard manual reading mode. Methods: From May to December 2023, 242 consecutive patients (mean age 50.17 years, SD 18.3; 53% female) underwent small bowel capsule endoscopy at two UK centres for suspected Crohn’s disease (48.8%), iron-deficiency anemia (23.6%), bleeding (18.6%), or other (9%). Seven experienced readers reviewed videos in standard mode (blinded to clinical data), then AI-assisted (MiroCam AI Scan) methods were applied after de-identification/randomization. Two experts provided reference standards. No adverse events occurred. Results: AI-assisted reading had sensitivity 95.3% (95% CI 90.1–98.3%) and specificity 96.5% (95% CI 91.3–99.0%) for diagnostic findings, vs. standard reading: 96.5% (95% CI 91.2–99.0%) and 85.3% (95% CI 78.0–90.9%). The positive findings rate was 83.6% vs. 80.2% (p = 0.040). Reading time decreased by 52% (38.1 vs. 18.26 min; p < 0.001). Conclusions: AI-assisted reading offers high diagnostic accuracy, superior specificity and reduced reading times, supporting its adjunctive role with expert oversight. Registered: ERGO ID 82419.

AI-Assisted Double-Headed Capsule Endoscopy: Multicentre Prospective Diagnostic Accuracy Study Across Small Bowel Indications

Unrecognized chronic giardiasis detected by motorized spiral enteroscopy: seeing is believing!

FP1 AI-enhanced double-tip capsule endoscopy: a multicentre prospective study on the diagnostic accuracy and efficiency of MiroCam MC2000 across all indications

Aims The motorized spiral enteroscopy (MSE) is the latest advancement in enteroscopy;however, real-life data on efficacy and safety are scarce. 

Motorized Spiral Enteroscopy: preliminary results of a multicenter prospective experience in real life clinical setting

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Papers

Outcomes of Double Balloon-Enteroscopy in Elderly vs. Adult Patients: A Retrospective 16-Year Single-Centre Study

AI-Assisted Double-Headed Capsule Endoscopy: Multicentre Prospective Diagnostic Accuracy Study Across Small Bowel Indications

Unrecognized chronic giardiasis detected by motorized spiral enteroscopy: seeing is believing!

FP1 AI-enhanced double-tip capsule endoscopy: a multicentre prospective study on the diagnostic accuracy and efficiency of MiroCam MC2000 across all indications

Motorized Spiral Enteroscopy: preliminary results of a multicenter prospective experience in real life clinical setting