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
Research background

Obscure gastrointestinal (GI) bleeding is defined as persistent bleeding despite negative evaluation with both esophagogastroduodenoscopy and colonoscopy and is often secondary to small intestinal pathology. This form of GI bleeding has now become manageable with the introduction of single balloon enteroscopy or double balloon enteroscopy. Those with distorted anatomy may require thorough investigation of the upper GI tract during obscure GI bleeding, and balloon enteroscopy may be warranted.

Research motivation

Balloon enteroscopy can be warranted in instances of obscure GI bleeding in those with altered anatomy; however, literature remains limited on the overall diagnostic and therapeutic yields as well as the overall safety of these procedures in this patient population.

Research objectives

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.

Research methods

We performed an extensive literature search on PubMed, Google Scholar, Scopus, and Embase where relevant articles were carefully reviewed. Terms used for the search included “enteroscopy,” “obscure bleeding,” “gastrointestinal bleeding,” and “altered anatomy.” Further search with the Reference Citation Analysis database was conducted to ensure inclusion of the latest high impact articles. Prospective and retrospective reviews, case series, and case reports were all included. Data from each study that fit our inclusion criteria were extracted into an excel file in a systematic fashion. Statistical analysis in the form of descriptive statistics was reported from each study.

Research results

Following our literature search, 14 studies were included in our review. In total, there were 68 procedures performed with 61 unique patients that had undergone these procedures. From the available data in each study, there was an overall diagnostic yield of 48/59 (81%) and a therapeutic yield of 39/59 (66%). Five (7%) procedures were complicated by perforation.

Research conclusions

Our systematic review shows that balloon enteroscopy can be implemented in obscure GI bleeding in those with altered anatomy. Diagnostic and therapeutic yields were as high as 83% and 64% respectively. Given the overall perforation of 7%, caution is warranted in such cases. Further literature is needed to expand upon our findings.

Research perspectives

Balloon enteroscopy remains a viable option to investigate obscure GI bleeding in those with altered anatomy. Caution is warranted given the reported perforation rates; however, further studies are needed to add to the limited available literature.