Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 16, 2022; 14(7): 434-442
Published online Jul 16, 2022. doi: 10.4253/wjge.v14.i7.434
Role of balloon enteroscopy for obscure gastrointestinal bleeding in those with surgically altered anatomy: A systematic review
Mahmoud Aryan, Tyler Colvin, Ali M Ahmed, Kondal Rao Kyanam Kabir Baig, Shajan Peter
Mahmoud Aryan, Tyler Colvin, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, United States
Ali M Ahmed, Kondal Rao Kyanam Kabir Baig, Shajan Peter, Department of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294, United States
Author contributions: Aryan M, Colvin T, and Shajan P designed the research; Aryan M and Colvin T performed the systematic review; Aryan M analyzed the data; Aryan M, Colvin T, and Shajan P wrote the paper; Shajan P, Kyanam Kabir Baig KR, and Ahmed A supervised the paper; all authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
Corresponding author: Shajan Peter, MD, Associate Professor, Department of Gastroenterology and Hepatology, University of Alabama at Birmingham, 1808 7th Avenue South, BDB 391, Birmingham, AL 35294, United States.
Received: January 11, 2022
Peer-review started: January 11, 2022
First decision: March 10, 2022
Revised: March 16, 2022
Accepted: June 3, 2022
Article in press: June 3, 2022
Published online: July 16, 2022

Obscure gastrointestinal (GI) bleeding is defined as persistent bleeding despite negative evaluation with both esophagogastroduodenoscopy and colonoscopy and can be secondary to small intestinal pathology. Standard endoscopy as well as push endoscopy can be a challenge in those with altered anatomy given inaccessible areas as well as perforation risk. Single and double balloon enteroscopy can be warranted in this patient population in instances of obscure GI bleed.


To assess the safety and diagnostic efficacy of balloon enteroscopy for obscure GI bleeding in patients with surgically altered anatomy.


A search was conducted through PubMed, MEDLINE, Google Scholar, Scopus, and Embase with the key words “enteroscopy,” “obscure bleeding,” and “altered anatomy,” to identify relevant articles in English with no restricted time frame. A search within the Reference Citation Analysis database was conducted to ensure inclusion of the latest high impact articles. Study types included in the review were prospective and retrospective reviews, case series, and case reports. The reference lists of these papers were also reviewed to find further papers that were applicable. The authors extracted the data from the studies that fit inclusion criteria. Data of interest included type of study, type of procedure, and type of altered anatomy, as well as the number of patients with any diagnostic or therapeutic intervention. Data was also recorded on procedure tolerance and complications. The data was analyzed with descriptive statistics.


Our literature search yielded 14 studies that were included. There were 68 procedures performed with 61 unique patients subjected to these procedures. Forty-four (65%) of the procedures were double balloon, 21 (31%) were single balloon, and 3 (4%) were classified as through the scope balloon assisted. The most common altered anatomy types included Gastric Bypass Roux-en-Y, Pylorus Sparing Whipple, Orthotopic Liver Transplantation with Roux-en-Y, and Gastrojejunostomy Roux-en-Y. The procedures were successfully performed in each patient. There were 5 (7%) procedures that were complicated by perforation. Amongst the available data, the diagnostic yield was 48/59 (81%) and a therapeutic yield of 39/59 (66%). One patient was recommended surgical revision of their altered anatomy following enteroscopy.


Balloon enteroscopy is a useful diagnostic modality in investigating obscure GI bleeding within those with surgically altered anatomy; however, precautions must be taken as this population may have increased perforation risk.

Keywords: Altered anatomy, Single balloon enteroscopy, Double balloon enteroscopy, Obscure, Bleed, Gastrointestinal

Core Tip: Balloon enteroscopy is often warranted in patients with surgically altered anatomy who suffer from obscure gastrointestinal (GI) bleeding. Data remain limited on the clinical utility of single or double balloon enteroscopy in those with altered anatomy. The primary aim of this systematic review was to assess the diagnostic and therapeutic efficacy of balloon enteroscopy for obscure GI bleeding in patients with surgically altered anatomy. The secondary aim was to investigate the safety of balloon enteroscopy in this patient population.