SINGLE VERSUS DOUBLE BALLOON ENTEROSCOPY FOR SMALL-BOWEL EVALUATION: UPDATED SYSTEMATIC REVIEW AND META-ANALYSIS OF EFFICACY AND SAFETY WITH EMPHASIS ON OBSCURE GI BLEEDING DETECTION.
Hamza Altal1, Mohammad Darweesh1, Saba Daher1, Usama Abu-Heija1, Asaiel Makahleh1, Chakradhar M Reddy11. Internal medicine, East Tennessee State University, Johnson City, TN, United States.
Background:
Single balloon enteroscopy (SBE) was developed to simplify device assisted enteroscopy compared with double-balloon enteroscopy (DBE), but its comparative diagnostic performance and safety remain uncertain. We aim to provide updated randomized evidence comparing the efficacy and safety of DBE vs SBE with emphasis on obscure GI bleeding detection (OGIB).
Methods:
We systematically searched PUBMED, EMBASE, Cochrane and ClinicalTrials.gov for randomized controlled trials (RCTs) and comparative cohort studies reporting outcomes for SBE vs DBE in adults undergoing small bowel evaluation. Two reviewers independently searched and extracted data. Random-effects models (DerSimonian-Laird) were used to calculate risk ratios (RR) with 95% confidence intervals (CI). Primary outcome was diagnostic yield. Secondary outcomes were total enteroscopy rate, therapeutic yield, OGIB detection, and procedure-related complications.
Results:
Ten studies met inclusion criteria (1,144 SBE and 2,513 DBE procedures). Overall diagnostic yield was similar between SBE and DBE RR 1.02 (95% CI 0.91-1.15; I2=57.7%). SBE achieved lower total enteroscopy completion rates than DBE RR 0.44 (95% CI 0.25-0.79; I2=38.1%). There was no difference in therapeutic yield RR 0.99 (95% CI 0.80-1.23; I2=60.4%). There was no difference in OGIB detection RR 0.93 (95%CI 0.77-1.12; I2=0.0%). Procedure-related complications were uncommon with no clear difference between the two RR 1.00 (95% CI 0.49-2.05; I2=0.0%).
Conclusion:
SBE provides similar diagnostic, OGIB detection and therapeutic yields with equivalent safety to DBE but accomplishes significantly lower total enteroscopy completion rates.
Forest Plots
Diagnostic Yield Forest PlotIMAGE CAPTION: Forest Plots
Diagnostic Yield Forest Plot
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