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Performance and safety of single-balloon enteroscopy and double-balloon enteroscopy for small-bowel disorders in
1Department of Pediatrics, Chengdu Integrated TCM & Western Medicine Hospital, Sichuan Province, No. 18 Wanxiang North Road, High-Tech Zone, Chengdu, 610000, China.
Insights
Single-balloon enteroscopy (SBE) and double-balloon enteroscopy (DBE) show promise for pediatric small-bowel disorders. However, pediatric procedures have lower complete enteroscopy rates, shallower insertion, and higher adverse events than adult procedures.
Area of Science:
- Gastroenterology
- Pediatric Endoscopy
- Minimally Invasive Procedures
Background:
- Balloon enteroscopy, including single-balloon enteroscopy (SBE) and double-balloon enteroscopy (DBE), is established for adult small-bowel diseases.
- Pediatric application of balloon enteroscopy presents unique challenges due to anatomical differences, with uncertain performance and safety outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of SBE and DBE in pediatric patients with small-bowel disorders.
- To compare pediatric balloon enteroscopy outcomes with existing adult data.
Main Methods:
- A comprehensive literature search identified studies on SBE and DBE in pediatric small-bowel disorders.
- A univariate random-effects meta-analysis was conducted on data from 24 studies (1463 patients).
- Primary outcomes included diagnostic yield, therapeutic yield, and adverse event incidence.
Main Results:
- Pooled diagnostic yield was 0.72, therapeutic yield 0.61, and overall adverse event rate 5.50%.
- DBE achieved greater depth of maximal insertion and a higher complete enteroscopy rate than SBE.
- Pediatric procedures showed lower complete enteroscopy rates (0.10) and shallower insertion compared to adult data.
Conclusions:
- Both SBE and DBE appear safe and effective for pediatric small-bowel disorders.
- Pediatric balloon enteroscopy outcomes differ from adults, with shallower insertion, lower complete enteroscopy rates, and higher adverse events.
- Findings are preliminary due to low certainty of evidence, requiring further standardized research.
Abstract:
Single-balloon enteroscopy (SBE) and double-balloon enteroscopy (DBE) are widely used for diagnosing small-bowel disorders in adults. However, anatomical differences in children present unique challenges for operators. This meta-analysis evaluates the efficacy and safety of both techniques in pediatric patients, comparing results with adult data. A comprehensive literature search was performed to identify studies evaluating SBE and DBE in pediatric small-bowel disorders. Primary outcomes included diagnostic yield, therapeutic yield, and incidence of adverse events. Secondary outcomes included depth of maximal insertion (DMI), complete enteroscopy rate, and other relevant measures. A univariate random-effects meta-analysis was conducted. Twenty-four studies comprising 1463 patients were included. The pooled diagnostic yield was 0.72, therapeutic yield 0.61, oral DMI 211.6 cm, rectal DMI 137.9 cm, and complete enteroscopy rate 0.10. DBE achieved greater DMI and a higher complete enteroscopy rate than SBE, with other outcomes remaining comparable. The overall adverse event rate was 5.50%. Compared to data from adult meta-analyses, pediatric balloon enteroscopy (DBE and SBE) is associated with a lower rate of complete enteroscopy (0.44 in adults), a more limited depth of insertion (262 cm orally in adults), and a higher adverse event rate (2% in adults).
Conclusion:
This meta-analysis suggests that both SBE and DBE may be safe and effective for pediatric small-bowel disorders. However, outcomes in children, including shallower insertion, lower complete enteroscopy rates, and higher adverse events, differ from adults. Given the low certainty of evidence, these findings, particularly differences between techniques, are preliminary and require confirmation in future standardized studies.
Trial Registration:
The study protocol has been registered in PROSPERO ( https://www.crd.york.ac.uk/prospero ) under the registration number CRD420251131086.
What Is Known:
• Balloon enteroscopy (DBE and SBE) is well-established for small-bowel diseases in adults. • Due to anatomical differences, balloon enteroscopy faces challenges in pediatric applications, and its performance and safety in children remain uncertain.
What Is New:
• This first meta-analysis to directly compare SBE and DBE in children demonstrates comparable diagnostic and therapeutic yields. • Pediatric procedures are associated with lower complete enteroscopy rates, shallower insertion, and higher adverse event rates compared to adults.
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