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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Single-balloon and spiral enteroscopy may have similar diagnostic and therapeutic yields to double-balloon enteroscopy: Results from a meta-analysis of randomized controlled trials and prospective studies
Yong Gu, Xin Shi, Yan Yang, Xiao-Fei Ye, Qiong Wu, Zhi-Ping Yang, Shui-Xiang He
Yong Gu, Shui-Xiang He, Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
Yong Gu, Department of Digestive System Diseases, Shaanxi Provincial Crops Hospital of Chinese People's Armed Police Force, Xi'an 710054, Shaanxi Province, China
Xin Shi, Yan Yang, Qiong Wu, Zhi-Ping Yang, State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, Shaanxi Province, China
Xiao-Fei Ye, Department of Health Statistics, Second Military Medical University, Shanghai 200433, China
Author contributions: Gu Y, Shi X, and Yang Y contributed equally to this work; He SX and Yang ZP were the co-corresponding authors, and contributed to study conception and design; Shi X and Wu Q performed the analysis and interpretation of the data; Gu Y and Yang Y drafted the manuscript; Yang ZP critically revised the article for important intellectual content; and He SX approved the final manuscript.
Conflict-of-interest statement: All authors declare no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shui-Xiang He, MD, PhD, Chief Doctor, Professor, Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, Shaanxi Province, China. hesx123@126.com
Received: December 12, 2019
Peer-review started: December 12, 2019
First decision: January 7, 2020
Revised: January 7, 2020
Accepted: March 22, 2020
Article in press: March 22, 2020
Published online: April 28, 2020
BACKGROUND
Double-balloon, single-balloon, and spiral enteroscopy (DBE, SBE, and SE) have revolutionized the management of intestinal diseases. However, evidence about efficacies of these methods is lacking. We aimed to conduct a meta-analysis comparing the clinical outcomes among DBE, SBE, and SE.
METHODS
We searched randomized controlled trials and prospective studies in MEDLINE, PubMed, EMBASE, Cochrane Library, and Chinese CQVIP database. Studies referencing the comparison of at least two of these three methods were included. Primary outcome was diagnostic yield. Other outcomes were therapeutic yield, total enteroscopy, examination time, time to maximum insertion, and depth of maximal insertion (DMI).
RESULTS
Eleven studies including 727 patients were identified: DBE vs SE (n = 6), DBE vs SBE (n = 4), and SBE vs SE (n = 1). The diagnostic and therapeutic yields did not differ significantly when comparing DBE with SE [odds ratio (OR) = 1.19, 95% confidence interval (CI): 0.68-2.08; OR = 1.17, 95%CI: 0.61-2.23] and DBE with SBE (OR = 0.85, 95%CI: 0.55-1.33; OR = 1.71, 95%CI: 0.64 - 4.60). Total enteroscopy, examination time, time to maximum insertion, and DMI were similar between SBE and DBE. DBE was superior to SE with regard to DMI [mean difference (MD) = 36.76, 95%CI: 5.09-68.43], with longer time to maximum insertion (MD = 15.14, 95%CI: 12-18.27) and examination time (MD = 12.98, 95%CI: 9.57-16.38).
CONCLUSION
DBE and SBE have similar clinical outcomes. Compared with DBE, SE seems to have similar diagnostic and therapeutic yields, but shorter procedural time in cost of less depth of insertion. SE needs further evaluation vs SBE. DBE is recommended for complete enteroscopy.
Core tip: We conducted a meta-analysis to compare the effectiveness of double-balloon, single-balloon, and spiral enteroscopy. We found that double-balloon enteroscopy may have similar clinical outcomes to single-balloon enteroscopy, and spiral enteroscopy seems to have similar diagnostic and therapeutic yields, but shorter procedural time in cost of less depth of insertion when compared with double-balloon enteroscopy.
