Systematic Review
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2017; 23(45): 8073-8081
Published online Dec 7, 2017. doi: 10.3748/wjg.v23.i45.8073
Double-balloon enteroscopy-assisted dilatation avoids surgery for small bowel strictures: A systematic review
Judith E Baars, Ruben Theyventhiran, Patrick Aepli, Payal Saxena, Arthur J Kaffes
Judith E Baars, Ruben Theyventhiran, Patrick Aepli, Payal Saxena, Arthur J Kaffes, AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, Sydney NSW 2050, Australia
Author contributions: Baars JE performed the research and wrote the manuscript, Theyventhiran R and Aepli P collected and reviewed the data; Saxena P and Kaffes AJ managed the study; all authors read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Arthur J Kaffes, MBBS, FRACP, Associate Professor, AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Suite G10, RPA Medical Centre, 100 Carillon Ave, Camperdown, Sydney NSW 2050, Australia. arthur@kaffes.com
Telephone: +61-295-162033 Fax: +61-295-160778
Received: July 20, 2017
Peer-review started: July 20, 2017
First decision: September 4, 2017
Revised: September 17, 2017
Accepted: October 17, 2017
Article in press: October 17, 2017
Published online: December 7, 2017
ARTICLE HIGHLIGHTS
Research background

At present there is a wealth of literature on the value of double-balloon enteroscopy (DBE) in the management of obscure gastrointestinal bleeding. However, there is only few data regarding its role in small bowel strictures. The management of small bowel strictures is complicated and these patients often face surgery, which has a huge impact on their quality of life.

Research motivation

In this study we aimed to evaluate the therapeutic role of DBE in small bowel strictures. In addition, we aimed to propose a standard approach to the management of small bowel strictures.

Research objectives

The main objective of this manuscript was to assess the efficacy and safety of DBE-assisted balloon dilatation of small bowel strictures. This is important as many of these patients often face surgery. The authors aimed to assess the role of DBE-assisted dilatation as an alternative for surgery.

Research methods

This study is a systematic review of published papers on DBE-assisted dilatation of small bowel strictures. Only studies limited to small bowel strictures were included and those with ileo-colonic strictures were excluded.

Research results

In total 13 studies were included, in which 310 patients were dilated. The average follow-up time was 31.8 mo per patient. The complication rate was 4.8% per patient and 2.6% per dilatation. Surgery was avoided in 80% of patients. After the first dilatation, 46% were treated with re-dilatation and only 17% required surgery.

Research conclusions

In this systematic review we demonstrate that double-balloon assisted dilatation is a safe and effective treatment for small bowel strictures. Four out of five patients avoid surgery due to double-balloon assisted dilatation of their small bowel stricture in an average follow-up of 2.5 years per patient. Moreover, we propose a flow-chart representing a standard approach to small bowel strictures.

Research perspectives

This research shows that double-balloon assisted balloon-dilatation is a safe and effective treatment for small bowel strictures and should be considered as a first treatment options. Future research is needed to explore the options of balloon-assisted enteroscopy in other device-assisted enteroscopy modalities.