Background: Motorized spiral enteroscopy (MSE) has been shown to be safe and effective for deep enteroscopy in studies performed at expert centers with limited numbers of patients without previous abdominal surgery. This study aimed to investigate the safety, efficacy, and learning curve associated with MSE in a real-life scenario, with the inclusion of patients after abdominal surgery and with altered anatomy. Methodsâ Patients with indications for deep enteroscopy were enrolled in a prospective observational multicenter study. The primary objective was the serious adverse event (SAE) rate; secondary objectives were the diagnostic and therapeutic yield, procedural success, time, and insertion depth. Data analysis was subdivided into training and core (post-Training) study phases at centers with different levels of MSE experience. Resultsâ 298 patients (120 women; median age 68, range 19-92) were enrolled. In the post-Training phase, 21.5â Š% (nâ Š=â Š54) had previous abdominal surgery, 10.0â Š% (nâ Š=â Š25) had surgically altered anatomy. Overall, SAEs occurred in 2.3â Š% (7/298; 95â Š%CI 0.9â Š%-4.8â Š%). The SAE rate was 2.0â Š% (5/251) in the core group and 4.3â Š% (2/47) in the training group, and was not increased after abdominal surgery (1.9â Š%). Total enteroscopy was achieved in half of the patients (nâ Š=â Š42) undergoing planned total enteroscopy. In 295/337 procedures (87.5â Š%), the anatomical region of interest could be reached. Conclusionsâ This prospective multicenter study showed that MSE was feasible and safe in a large cohort of patients in a real-life setting, after a short learning curve. MSE was shown to be feasible in postsurgical patients, including those with altered anatomy, without an increase in the SAE rate.