The vast majority of gastrointestinal endoscopic procedures, both diagnostic and therapeutic, are currently performed under deep sedation in spontaneous ventilation.1, 2 In recent years, the complexity of endoscopic procedures has progressively increased,3 with resection of submucosal lesions and complex polyps,4 treatment of lesions in the small bowel (SB), drainage of collections and repair of suture dehiscence endoscopically without the need for surgery.5, 6, 7 Although these procedures are performed in gastrointestinal endoscopy units (GEU), they may require the induction of general anaesthesia (GA) as the anaesthetic technique of choice, in view of the higher degree of complexity, longer duration and greater compromise of the patient's airway.8, 9, 10

In 2019, the Power Spiral enteroscope was introduced in our hospital (Hospital Clínic de Barcelona [HCB]) for routine clinical practice. It has a flexible overtube in the shape of a helix or spiral (Fig. 1), making advancement over the SB continuous and faster.11 Thanks to a pedal-operated integrated motor, the overtube rotates clockwise and anticlockwise, allowing it to advance in the SB. If it meets increased resistance, the motor is automatically blocked, avoiding major complications.12, 13, 14 This enables exploration of a greater extension of the SB, reducing the examination time and improving the diagnostic capacity of enteroscopy.15, 16, 17, 18, 19 The technical characteristics of the motorised spiral enteroscope mean that both the advancement and withdrawal of the enteroscope have to be gradual, as, if the overtube is withdrawn quickly, it would remain stuck to the SB mucosa and could cause intussusception, laceration or even perforation.19 These particular features of antegrade motorised spiral enteroscopies (MSE) make it very difficult to rescue the airway during the procedure, and it is recommended that this technique be performed under GA to guarantee patient safety at all times.16, 17

Performing anaesthesia procedures and GA in particular outside the surgical area is associated with a higher incidence of adverse events.3 Most of these are related to the lack of experience of healthcare staff working in these areas, insufficient infrastructure and architectural barriers resulting from the fact that these areas were not initially designed for this purpose; for example, in interventional radiology, gastrointestinal endoscopy and electrophysiology units.20, 21, 22

The implementation of antegrade MSE under GA at the HCB GEU has required the review and update of our care protocol. However, there is no evidence on the anaesthetic requirements of patients undergoing antegrade MSE. Our main objective for this study was therefore to describe the anaesthetic management during antegrade MSE. We also evaluated the incidence of complications during the procedure and 24 h later. Lastly, we analysed the association between difficulty in inserting and withdrawing the MSE and the characteristics of the patient's airway.