Post written by Ramkaji Baniya, MD, and Prabin Sharma, MD, from the Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan, and the Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut.

Our systematic review and meta-analysis aimed to compare the efficacy and safety of different deep enteroscopic procedures.

Deep enteroscopic procedures include balloon enteroscopy (BE; single and double balloon) and spiral enterosocopy (SE). By virtue of these enteroscopic platforms, small-bowel disorders that historically required operative intervention can be managed non-surgically. However, there are very few studies with small sample sizes comparing these procedures in terms of diagnostic and therapeutic yield, procedure length, depth of maximal insertion, and rates of adverse events.

Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow diagram.

A total of 615 deep enteroscopic procedures were analyzed, which included 394 balloon enteroscopy and 221 spiral enteroscopy procedures. There were no significant differences in diagnostic and therapeutic success rates (OR, 1.27; 95% confidence interval (CI), 0.86–1.88; P=.22 and OR, 1.23; 95% CI, 0.82–1.84; P=.32, respectively) between the 2 procedures. Similarly, Depth of Maximal Insertion (DMI) was not significantly different between the 2 groups (MD, 26.29; 95% CI, 20.92–73.49; P=.28). However, the procedure time was significantly less for the SE group compared with BE (MD, 11.26; 95% CI, 2.72–19.79; P=.010). A subgroup analysis comparing double-balloon enteroscopy to spiral enteroscopy yielded similar results.

In summary, our study shows that diagnostic and therapeutic success rates as well as depth of maximal insertion are similar for both BE and SE. Spiral enteroscopies, however,  are of significantly shorter duration providing a faster evaluation of the small bowel. Most of the studies included in our analysis were non-randomized single-center studies, and future prospective randomized multi-center studies are warranted to corroborate our findings.

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