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Bile acid sequestrants in poor healing after endoscopic therapy of Barrett’s esophagus
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Lukas Welsch, Andrea May, Tobias Blasberg, Jens Wetzka, Elisa Müller, Myriam Heilani, Mireen Friedrich-Rust, Mate Knabe
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Clin Endosc 2023;56(2):194-202. Published online March 9, 2023
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DOI: https://doi.org/10.5946/ce.2022.121
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 Graphical Abstract
 Abstract
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 - Background
/Aims: Endoscopic therapy for neoplastic Barrett’s esophagus (BE) has become the standard of care over the past two decades. In clinical practice, we regularly encounter patients who fail to achieve complete squamous epithelialization of the esophagus. Although the therapeutic strategies in the individual stages of BE, dysplasia, and esophageal adenocarcinoma are well studied and largely standardized, the problem of inadequate healing after endoscopic therapy is only marginally considered. This study aimed to shed light on the variables influencing inadequate wound healing after endoscopic therapy and the effect of bile acid sequestrants (BAS) on healing.
Methods
Retrospective analysis of endoscopically treated neoplastic BE in a single referral center.
Results
In 12.1% out of 627 patients, insufficient healing was present 8 to 12 weeks after previous endoscopic therapy. The average follow-up duration was 38.8±18.4 months. Complete healing was achieved in 13 patients already after intensifying proton pump inhibitor therapy. Out of 48 patients under BAS, 29 patients (60.4%) showed complete healing. An additional eight patients (16.7%) improved, but only partial healing was achieved. Eleven (22.9%) patients showed no response to BAS augmented therapy.
Conclusions
In cases of insufficient healing even under exhaustion of proton pump inhibitors, treatment with BAS can be an option as an ultimate healing attempt.
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Citations
Citations to this article as recorded by  - Clinicians should be aware of proton pump inhibitor–related changes in the gastric mucosa
Gwang Ha Kim
Clinical Endoscopy.2024; 57(1): 51. CrossRef - Seeking to understand non-responders to ablative therapy for dysplastic Barrett's esophagus
Bryan G. Sauer
Clinical Endoscopy.2023; 56(2): 180. CrossRef
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Double-balloon is equal to motor-spiral-enteroscopy in a german prospective, randomized trial
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Mate Knabe, Myriam Heilani, Jens Wetzka, Lukas Welsch, Georg Dultz, Insa Aschmoneit-Messer, Eva Herrmann, Stefan Zeuzem, Andrea May
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Received November 15, 2024 Accepted February 6, 2025 Published online July 7, 2025
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DOI: https://doi.org/10.5946/ce.2024.308
[Epub ahead of print]
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Graphical Abstract
Abstract
PDFPubReaderePub
 - Background
/Aims: Deep enteroscopy is a challenging and time-consuming procedure. Two devices have become the clinical standards for patients: double-balloon enteroscopy (DBE) and motorized spiral enteroscopy (mSPE). Initially, mSPE demonstrated impressive results, with high rates of total enteroscopy, which were superior to those of all other devices. However, for safety reasons, mSPE was withdrawn from the market, and it remains uncertain whether it will return after technical improvements. This prospective randomized trial aimed to compare the DBE and mSPE.
Methods
Patients indicated for enteroscopy were randomized to undergo either mSPE or DBE. The time to diagnosis or complete enteroscopy was measured, and all complications were recorded.
Results
A total of 48 enteroscopic procedures were performed, including 23 mSPE and 25 DBE. No significant difference was noted in the procedure time (t-test, p=0.212). The mSPE group exhibited a shorter mean procedure time of 54 (range, 15–114; standard deviation [SD], 26) minutes, whereas the DBE group had a shorter mean procedure time of 63 (range, 20–131; SD, 25) minutes. One perforation was seen in the mSPE group.
Conclusions
DBE and mSPE are both effective enteroscopy methods but showed no significant difference in this randomized trial (German trial registry: DRKS 00025890).
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