Table 4.

Description of major adverse events according to AGREE classification.

AGREE classification	Adverse event description	Patients (n)	Related to MSE	Follow-up
Grade II	Withdrawal issues During anterograde MSE, difficult and prolonged withdrawal of the enteroscope was experienced at mid-proximal esophagus, without significant esophageal lesions or therapeutic intervention, but requiring 24–36 h of hospital admission	4	Yes	No sequelae
	Self-limited Intestinal hemorrhage A patient with mitral insufficiency and atrial fibrillation on acenocoumarol underwent anterograde MSE. A 20 mm polyp was detected and treated with epinephrine injection, hot snare polypectomy, and hemostatic clip placement. No immediate complications. After 48 h of anticoagulation reintroduction, patient had self-limited melena and was observed for 48 h at the hospital without further intervention	1	No	No sequelae
Grade IIIb	Jejunal acute ischemia An 80-year-old man presented with a 10 mm angiodysplasia in the jejunum detected by CE. The lesion was identified through MSE and treated with APC, epinephrine and polidocanol due to persistent bleeding. Ultimately, two hemostatic clips were placed. Patient was discharged asymptomatic At 48 h following MSE, the patient experienced acute abdominal pain along with leukocytosis. A CT scan revealed acute jejunal ischemia, leading to the confirmation of transmural ischemic necrosis through jejunal resection	1	No	No sequelae

APC Argon plasma coagulation; CE Capsule endoscopy; MSE Motorized spiral enteroscopy; CT Computerized tomography.