Diagnostic yield and technical performance of the novel motorized spiral enteroscopy compared with single-balloon enteroscopy in suspected Crohn's disease: a prospective study (with video).

BACKGROUND AND AIMS: Both single-balloon enteroscopy (SBE) and the novel motorized spiral enteroscopy (NMSE) are effective techniques for device-assisted enteroscopy (DAE). To date, no study has prospectively compared both modalities in suspected Crohn's disease (CD). METHODS: Patients with suspected CD undergoing either SBE or NMSE between March 2021 and December 2021 in a high-volume tertiary center were prospectively compared for technical success (ability to reach the lesion), diagnostic yield, depth of maximal insertion (DMI), procedure time, and total enteroscopy rates. RESULTS: One hundred seventy-seven patients (37.2% female; aged 7-75 years) with suspected CD underwent 201 DAEs. Technical success was 83% (SBE 81.5% vs NMSE 87.3%, P = .61) and impacted subsequent management in 92% (SBE 88.5% vs NMSE 97.8%, P = .2). Technical success with antegrade NMSE was significantly higher (81.4%) than antegrade SBE (33.3%, P = .007) for lesions in the proximal ileum and beyond. There was no significant difference in the diagnostic yield (SBE 80.8% vs NMSE 83.6%, P = .65). Median procedure time was significantly lower in both antegrade (NMSE, 40 minutes [range, 10-75]; SBE, 60 minutes [range, 20-180]; P < .0001) and retrograde (NMSE, 25 minutes [range, 20-60]; SBE, 60 minutes [range, 20-180]; P < .0001) NMSE. Median DMI was higher with antegrade NMSE (NMSE, 400 cm [range, 70-600]; SBE, 180 cm [range, 60-430]; P < .0001). The total enteroscopy rate was higher with NMSE (37% vs .7% with SBE, P < .0001). All adverse events were mild. CONCLUSIONS: Both NMSE and SBE are safe and effective for small-bowel evaluation in suspected CD. NMSE is superior to SBE with regard to deeper small-bowel evaluation with complete small-bowel coverage and shorter procedure time.

Depression and active disease are the major risk factors for fatigue and sleep disturbance in inflammatory bowel disease with consequent poor quality of life: Analysis of the interplay between psychosocial factors from the developing world.

BACKGROUND AND OBJECTIVES: The prevalence and risk factors of fatigue and sleep disturbances in inflammatory bowel disease (IBD) patients and their impact on the quality of life (QOL) are largely underreported in the developing world, where IBD is on the rise. METHODS: Consecutive patients attending the IBD clinic were interviewed between November 2021 and March 2022 using an assisted questionnaire (English, Hindi and Telugu versions)(including demographics, disease activity, QOL, IBD fatigue score [IBD-F], Hospital anxiety and depression score: [HADS], Pittsburg Sleep Quality Index: [PSQI]). Logistic regression was used to identify risk factors of fatigue and sleep disturbance. A correlational analysis between mental health factors and QOL was performed. RESULTS: AS many as 202 IBD patients (age 18-78 [median 31] years, 65.8% male) completed the questionnaires. Fatigue and sleep disturbances were highly prevalent (55.9% and 53.4%, respectively). On multi-variate analysis, depression (p = 0.008, odds ratio [OR] -1.38, 95% confidence interval [CI] -1.09-1.75), active disease (p = 0.001,OR-8.81,95% CI- 2.49-31.23) and poor sleep (p = 0.009, OR-1.17, 95% CI:1.04-1.31) were predictive of fatigue, whereas depression (p < 0.001,OR-1.32,95% CI-1.19-1.46) and active disease (p < 0.001,OR-6.77, 95% CI-2.67-17.17) were predictive of sleep disturbance. On sub-group analysis, poor sleep quality and lack of renumeration predicted fatigue, whereas old age and female gender predicted poor sleep quality in Crohn's disease (CD). QOL (Short IBD questionnaire: [SIBDQ]) scores had a strong and moderate negative correlation with IBD-F (r = -0.735, p < 0.0001) and PSQI (r = -0.682, p < 0.001) scores, respectively. The results should be interpreted in the context of lack of validated translated questionnaires in all native languages in a multilingual country. Translational assistance was provided to overcome the limitation. CONCLUSION: Fatigue and sleep disturbances are highly prevalent in Indian IBD patients. Apart from modulation of disease activity, screening those with mental health illness may help improve fatigue/sleep quality and overall QOL.