Motorized spiral enteroscopy versus double-balloon enteroscopy: a case-matched study.

BACKGROUND AND AIMS: Motorized spiral enteroscopy (MSE) has been postulated to ease the complexities of the standard-of-care double-balloon enteroscopy (DBE). However, there are no comparative studies between MSE and DBE. This study aimed to compare the therapeutic outcomes and safety between MSE and DBE. METHODS: In this case-matched study, patients were matched 1:2 (MSE/DBE) by age, sex, body mass index, and American Society of Anesthesiology scores. Thirty-one patients who underwent MSE were compared with 62 patients who underwent DBE from 2014 to 2022. Our primary outcomes were to compare the technical and diagnostic success rates between DBE and MSE. Our secondary outcomes were to compare the therapeutic success and adverse event rates. RESULTS: The main indications for enteroscopy were suspected GI bleeding and positive radiologic findings. Prior abdominal surgery was reported in 35.5% and 22.6% of DBE and MSE patients, respectively. Most were antegrade enteroscopy (71%). We found no significant difference in the technical success (DBE 98.4% vs MSE 96.8%, P = .62), diagnostic success (DBE 66.1% vs MSE 54.8%, P = .25), and therapeutic success rates (DBE 62.8% vs MSE 52.9%, P = .62) between the groups. Adverse events occurred in 1 DBE and 11 MSE patients. Most were minor (n = 10, 25.6%). Two patients (5.1%) in the MSE group sustained deep lacerations in the proximal esophagus requiring hospitalization. One developed ileal perforation after MSE needing surgical repair. CONCLUSIONS: In patients requiring enteroscopy, the diagnostic and therapeutic performance of MSE is similar to DBE. An increased frequency of adverse events was observed with MSE. There are some restrictions in the indication because of the design of MSE.

Use of Population-Based Cancer Registry Data to Determine the Effect of Timely Treatment on the Survival of Colorectal Cancer Patients.

INTRODUCTION: Colorectal cancer is the third most common cancer in the world. In Singapore, it was the most common cancer in males and second most common cancer in females from 2009 to 2013. The incidence for colorectal cancer is declining, but the mortality remains high. Cancer of the colon is a highly treatable and curable disease when it is localized to the bowel. Timely treatment of cancer, which is defined as the interval between date of diagnosis and starting date of treatment within an assigned time frame, plays an important role for the survival of patients. This is the first study in Southeast Asia looking at multiethnic groups. The study attempts to determine the effect of timely treatment on survival of colorectal cancer patients by using the Singapore cancer registry data. METHODS: Histologically proven colorectal cancer cases of the residents in Singapore diagnosed in 2008-2012 were included. Exclusion criteria for the study were neuroendocrine carcinomas, soft tissue sarcoma, and lymphoma of the bowel. Bivariate analysis was used to describe patient demographic and disease characteristics by survival status of patient as well as by treatment types and stage group. Timely surgery, adjuvant therapy, and neoadjuvant treatment modalities were defined. Cox regression analysis was used to determine the effect of timely treatment on survival of patients by controlling other independent variables of age, sex, the stage of disease, and ethnicity. RESULTS: A total of 7,739 patients were included in this study. Colorectal cancer was more common in males (55.8%) than in females (44.2%), with a median age of 65.5 years for males and 67.1 years for females. It was more common in Chinese ethnicity (87.7%) followed by Malay (7.4%) and Indian (3.2%). About 40% of patients were diagnosed in early stage and 54.3% in late stage. Primary subsites in order of frequency were sigmoid colon (29%) and rectum (24.4%), followed by rectosigmoid colon (11.4%). About 86% of patients had surgery, of which 47% were treated by surgery alone. More than 75% of patients received timely treatment. Cox regression analysis produced a hazard ratio (HR) of 1.18 (95% CI, 1.02-1.36) for patients who did not receive any type of timely first treatment, an HR of 1.35 (95% CI, 1.17-1.57) for patients with no timely surgery, an HR of 1.4 (95% CI, 1.21-1.62) for patients with no timely adjuvant chemotherapy, and an HR of 2.05 (95% CI, 1.23-3.41) for patients with no timely neoadjuvant therapy. CONCLUSION: The study shows that there were significant effects of timely treatment on survival. Information on the timely treatment modalities and its benefits should be included in the public education and emphasized during the treatment planning with patients for better compliance and improved outcomes. Some delays are avoidable and perhaps the causes of these avoidable delays should be identified and resolved to further enhance quality of service in health care.