Water exchange-assisted versus carbon dioxide-insufflated single-balloon enteroscopy: a randomized controlled trial

Area of Science:

• Gastroenterology
• Endoscopy
• Medical Devices

Background:

• Single-balloon enteroscopy (SBE) is crucial for diagnosing and treating small-bowel conditions but presents technical challenges.
• The water exchange method, known to aid colonoscopy intubation, was investigated for its utility in SBE.

Purpose of the Study:

• To evaluate the impact of the water exchange method on key procedural variables in single-balloon enteroscopy.
• To compare the efficacy and safety of water exchange-assisted SBE versus carbon dioxide (CO2)-insufflated SBE.

Main Methods:

• A randomized controlled trial involving 110 patients undergoing attempted total enteroscopy.
• Patients were randomized to either water exchange-assisted SBE or CO2-insufflated SBE.
• Primary outcome was the total enteroscopy rate; secondary outcomes included insertion depth, findings, time, and adverse events.

Main Results:

• The water exchange group achieved a significantly higher total enteroscopy rate (58.2% vs. 36.4%, P=0.02).
• Mean intubation depth was greater in the water exchange group (521.2 cm vs. 481.6 cm, P=0.04).
• Procedural time was longer with water exchange (178.9 min vs. 154.2 min, P<0.001), with comparable findings and adverse events.

Conclusions:

• Water exchange enhances the total enteroscopy rate and intubation depth in SBE procedures.
• The water exchange method is a safe adjunct for SBE, not increasing complication rates.