A meta-analysis on efficacy and safety: single-balloon vs. double-balloon enteroscopy

Vaibhav Wadhwa; Saurabh Sethi; Sumeet Tewani; Sushil Kumar Garg; Douglas K Pleskow; Ram Chuttani; Tyler M Berzin; Nidhi Sethi; Mandeep S Sawhney

doi:10.1093/gastro/gov003

A meta-analysis on efficacy and safety: single-balloon vs. double-balloon enteroscopy

Gastroenterol Rep (Oxf). 2015 May;3(2):148-55. doi: 10.1093/gastro/gov003. Epub 2015 Feb 18.

Authors

Vaibhav Wadhwa¹, Saurabh Sethi², Sumeet Tewani², Sushil Kumar Garg², Douglas K Pleskow², Ram Chuttani², Tyler M Berzin², Nidhi Sethi², Mandeep S Sawhney²

Affiliations

¹ Department of Internal Medicine, Fairview Hospital, Cleveland Clinic, Cleveland, OH, USA, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA and Division of Basic and Translational Research, Department of Surgery, University of Minnesota, Minneapolis, MN, USA wadhwav@ccf.org.
² Department of Internal Medicine, Fairview Hospital, Cleveland Clinic, Cleveland, OH, USA, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA and Division of Basic and Translational Research, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.

Abstract

Background and aim: Double-balloon enteroscopy (DBE) and single-balloon enteroscopy (SBE) are new techniques capable of providing deep enteroscopy. Results of individual studies comparing these techniques have not been able to identify a superior strategy. Our aim was to systematically pool all available studies to compare the efficacy and safety of DBE with SBE for evaluation of the small bowel.

Methods: Databases were searched, including PubMed, Embase, and the Cochrane Central Register of Controlled Trials. The main outcome measures were complete small-bowel visualization, diagnostic yield, therapeutic yield, and complication rate. Statistical analysis was performed using Review Manager (RevMan version 5.2). Meta-analysis was performed using fixed-effect or random-effect methods, depending on the absence or presence of significant heterogeneity. We used the χ(2) and I(2) test to assess heterogeneity between trials. Results were expressed as risk ratios (RR) or mean differences with 95% confidence intervals (CI).

Results: Four prospective, randomized, controlled trials with a total of 375 patients were identified. DBE was superior to SBE for visualization of the entire small bowel [pooled RR = 0.37 (95% CI: 0.19-0.73; P = 0.004)]. DBE and SBE were similar in ability to provide diagnosis [pooled RR = 0.95 (95% CI: 0.77-1.17; P = 0.62)]. There was no significant difference between DBE and SBE in therapeutic yield [pooled RR = 0.78 (95% CI: 0.59-1.04; P = 0.09)] and complication rate [pooled RR = 1.08 (95% CI: 0.28-4.22); P = 0.91].

Conclusions: DBE was superior to SBE with regard to complete small bowel visualization. DBE was similar to SBE with regard to diagnostic yield, ability to provide treatment and complication rate, but these results should be interpreted with caution as they is based on very few studies and the overall quality of the evidence was rated as low to moderate, due to the small sample size.

Keywords: double-balloon enteroscopy; meta-analysis; outcomes; single-balloon enteroscopy; small bowel enteroscopy.

Publication types

Review