Complications of single-balloon enteroscopy: A nine-year multicenter experience of 2865 procedures

Single-balloon enteroscopy (SBE) is an established procedure for evaluating small bowel lesions. While its efficacy is well recognized, the incidence of major complications and their associated risk factors in a large population remain unclear.

To investigate the complications and risk factors associated with diagnostic SBE.

This multicenter retrospective study included consecutive patients who underwent diagnostic SBE at three tertiary care hospitals between January 2016 and September 2024. Data on baseline characteristics, procedural parameters, indications, findings, and major complications were collected and analyzed.

A total of 2865 SBE procedures were performed in 1840 patients. The mean age was 51 ± 18 years, and 64.5% were male. The most common indication was obscure gastrointestinal bleeding (57.1%), followed by abdominal pain (30.5%). The major complication rate was 0.4% (7/1840), all of which involved acute intestinal perforation identified during the procedure. Among the perforation cases, 6 occurred in patients undergoing SBE for abdominal pain and 1 for obscure gastrointestinal bleeding. The perforation sites included the ileum (6/7) and duodenum (1/7). All cases were successfully managed surgically. Previous abdominal surgery and the use of abdominal compression were significantly associated with an increased risk of perforation (P value < 0.001 for both). In subgroup analysis, perforation rates were 2.1% (6/288) in patients with prior abdominal surgery and 1.6% (7/428) with abdominal compression.

Acute intestinal perforation is a rare but serious complication. Prior abdominal surgery and abdominal compression are important risk factors, and careful patient selection is recommended to minimize complications.