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Deep enteroscopy in children: techniques, applications, and future directions
1Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at IU Health, Indianapolis, IN, United States.
Insights
Deep enteroscopy techniques, including push enteroscopy (PE) and balloon-assisted enteroscopy (BAE), significantly improve diagnosis and treatment for pediatric small bowel disorders. BAE offers deeper access for complex conditions, enhancing patient outcomes.
Area of Science:
- Pediatric Gastroenterology
- Minimally Invasive Endoscopy
- Gastrointestinal Diagnostics
Background:
- Deep enteroscopy, comprising push enteroscopy (PE) and balloon-assisted enteroscopy (BAE), has transformed pediatric small bowel disorder management.
- PE is useful for proximal small bowel issues, but BAE techniques (single-balloon enteroscopy [SBE] and double-balloon enteroscopy [DBE]) offer superior depth and stability for comprehensive evaluation and treatment.
Purpose of the Study:
- To review the evolving role and effectiveness of deep enteroscopy techniques in diagnosing and treating pediatric small bowel disorders.
- To highlight the diagnostic yields, therapeutic capabilities, safety profiles, and challenges associated with PE and BAE in children.
- To identify future directions, including comparative analyses and technological advancements, for optimizing deep enteroscopy in pediatric care.
Main Methods:
- Review of current literature on deep enteroscopy (PE, SBE, DBE) in pediatric patients.
- Analysis of diagnostic yields and therapeutic interventions for various small bowel conditions (e.g., obscure GI bleeding, Crohn's disease, tumors).
- Evaluation of safety data and complication rates in pediatric populations.
Main Results:
- BAE techniques provide deeper access and enable advanced interventions like polypectomy, stricture dilation, and hemostasis in the pediatric small bowel.
- Pediatric data show high diagnostic yields for BAE, with comparable outcomes between SBE and DBE.
- While generally safe, younger children may have slightly higher complication rates due to anatomical factors.
Conclusions:
- Deep enteroscopy, particularly BAE, is a valuable tool for managing pediatric small bowel disorders, offering high diagnostic and therapeutic success.
- Further research, standardized training, and comparative studies with capsule endoscopy are needed to refine procedural selection and optimize outcomes.
- Technological innovations and tailored pediatric approaches will further enhance the role of deep enteroscopy in children's gastrointestinal health.
Abstract:
Deep enteroscopy, encompassing push enteroscopy (PE) and balloon-assisted enteroscopy (BAE), has revolutionized the diagnosis and treatment of pediatric small bowel disorders. This review examines the evolving role of these techniques in managing conditions such as obscure gastrointestinal bleeding, Crohn's disease, polyposis syndromes, strictures, and small bowel tumors. While PE is effective for both diagnostic and therapeutic interventions in the proximal small bowel, its limited insertion depth has driven the adoption of BAE techniques. These include single-balloon enteroscopy (SBE) and double-balloon enteroscopy (DBE), which provide deeper and more comprehensive access. Both BAE modalities offer greater insertion depth and stability, enabling advanced therapeutic interventions such as polypectomy, stricture dilation, and hemostasis. Pediatric-specific data demonstrate high diagnostic yields for BAE, with comparable outcomes between SBE and DBE. These techniques have proven safe across diverse indications, though younger children may experience slightly higher complication rates due to anatomical considerations. Despite these advancements, challenges persist, including a limited evidence base in pediatrics, barriers to training, and the need for standardized protocols. Additionally, emerging innovations such as artificial intelligence offer opportunities to enhance diagnostic accuracy and procedural efficiency. Comparative analyses of PE, BAE, and capsule endoscopy are necessary to refine procedural selection and optimize outcomes in pediatric patients. Furthermore, structured pediatric training programs and simulation-based learning could address competency gaps, ensuring safe and effective application of these techniques. By addressing current research gaps, embracing technological advancements, and tailoring approaches to pediatric populations, deep enteroscopy can continue to transform the management of small bowel disorders in children.
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