How to approach the small bowel with flexible enteroscopy

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Small Bowel Diagnostics

Background:

• Five nonsurgical flexible endoscopic techniques exist for small bowel examination.
• Push enteroscopy is limited to the proximal jejunum.
• Balloon-assisted enteroscopy (BAE) techniques, including double-balloon enteroscopy (DBE) and single-balloon enteroscopy (SBE), are widely used.

Purpose of the Study:

• To review current nonsurgical flexible endoscopic techniques for small bowel examination.
• To evaluate the role and efficacy of different enteroscopy methods.
• To establish the current gold standard for deep small bowel endoscopy.

Main Methods:

• Review of existing nonsurgical flexible endoscopic techniques: push enteroscopy (PE), balloon-assisted enteroscopy (BAE) with double-balloon enteroscopy (DBE) or single-balloon enteroscopy (SBE), balloon-guided enteroscopy (BGE), and spiral enteroscopy (SE).

Main Results:

• DBE is the oldest and most established BAE technique, widely used globally for diagnostic and therapeutic small bowel examinations.
• DBE provides the highest rates of complete enteroscopy, making it the current gold standard for deep small bowel procedures.
• Spiral enteroscopy (SE) is a newer technique with potential but requires further technical refinement and validation.

Conclusions:

• Double-balloon enteroscopy (DBE) remains the gold standard for deep small bowel endoscopy due to its high complete enteroscopy rates.
• Single-balloon enteroscopy (SBE) and DBE are the primary BAE techniques in current clinical practice.
• Further large-scale prospective studies are necessary to fully assess spiral enteroscopy (SE) and compare it with existing BAE systems.