Clinical Endoscopy

Review

Recent technological advances in device-assisted enteroscopy: Mi Rae Lee, Jin Su Kim; Clin Endosc 2026;59(2):194-202. Published online March 3, 2026; DOI: https://doi.org/10.5946/ce.2025.136

Device-assisted enteroscopy (DAE) has revolutionized small bowel evaluation by allowing endoscopic access for both diagnosis and therapy. Since the introduction of double-balloon enteroscopy, newer techniques such as single-balloon enteroscopy, spiral enteroscopy (SE), and balloon-guided systems have expanded clinical options. However, conventional DAE remains limited by procedural complexity, prolonged procedure times, and incomplete enteroscopy. In response, novel technologies have emerged to improve efficiency and outcomes. Among these, motorized power SE (PSE) represents a significant advancement, enabling deeper insertion and single-operator capability. Despite promising early results, PSE has been withdrawn from the market owing to safety concerns, particularly esophageal injuries. Nevertheless, recent studies suggest that PSE may still be a valuable rescue technique in selected cases in which balloon-assisted methods fail. Additional advances, including artificial intelligence-assisted lesion detection, are being integrated into modern DAE platforms. Continued innovation in imaging, device ergonomics, and procedural safety is essential to meet the evolving clinical demands. This review highlights the recent technological progress in DAE and discusses the challenges and future directions for integrating these tools into routine practices.

Citations

Citations to this article as recorded by

Diagnostic and therapeutic yield of double-balloon enteroscopy in small bowel diseases: a prospective cohort study
Waleed Hassan, Maiada Ibrahim, Mahmoud Moubark, Ahmed Yousif, Muhammad Abdel Ghaffar, Dalia Elsers, Ahlam Farghaly
The Egyptian Journal of Internal Medicine.2026;[Epub] CrossRef

3,494 View
121 Download
2 Web of Science
1 Crossref

Systematic Review and Meta-analysis

Spiral enteroscopy versus single-balloon enteroscopy for the evaluation and treatment of small bowel disorders: a systematic review and meta-analysis: Bisher Sawaf, Mohammed S. Beshr, Rana H. Shembesh, Mohammed Abu-Rumaileh, Wasef Sayeh, Azizullah Beran, Yusuf Hallak, Sami Ghazaleh, Muhammed Elhadi, Yaseen Alastal; Clin Endosc 2026;59(1):49-57. Published online October 10, 2025; DOI: https://doi.org/10.5946/ce.2025.184

Graphical Abstract Abstract PDF Supplementary Material: Background
/Aims: Device-assisted enteroscopy has advanced small bowel disorder management. We conducted this meta-analysis to compare the clinical and procedural outcomes between spiral enteroscopy and single-balloon enteroscopy.
Methods
A systematic search was performed on December 1, 2024, in the PubMed, Scopus, and Cochrane Library databases to identify studies that compared spiral enteroscopy and single-balloon enteroscopy. The outcomes included diagnostic and therapeutic yields, total procedure time, depth of maximum insertion, and adverse event rates.
Results
Five studies (including 496 patients) met the inclusion criteria. The diagnostic yield was similar between spiral enteroscopy and single-balloon enteroscopy (risk ratio [RR], 1.07; 95% confidence interval [CI], 0.96–1.20; p=0.24). The therapeutic yield also showed no significant difference (RR, 1.10; 95% CI, 0.45–2.69; p=0.83). The total procedure time was comparable (mean difference, –22.85 minutes; 95% CI, –46.83 to 1.12; p=0.06), although motorized spiral enteroscopy reduced the procedure time (p<0.001). Spiral enteroscopy achieved greater depth of maximum insertion (standardized mean difference, 1.33; 95% CI, 0.65–2.01; p<0.001). Adverse event rates were comparable (RR, 1.72; 95% CI, 0.80–3.70; p=0.16).
Conclusions
Spiral and single-balloon enteroscopies demonstrated similar diagnostic and therapeutic yields and safety. Spiral enteroscopy achieved a greater insertion depth, and motorized systems improved the efficiency in terms of procedure times.

3,418 View
193 Download

Review

Applying small bowel endoscopy in inflammatory bowel disease management: Seong-Jung Kim, Sung Noh Hong; Clin Endosc 2026;59(2):203-210. Published online September 29, 2025; DOI: https://doi.org/10.5946/ce.2025.144

Abstract PDF: Inflammatory bowel disease is classified into Crohn’s disease (CD) and ulcerative colitis. Ulcerative colitis involves only the colon, whereas CD is characterized by small bowel involvement, which is a hallmark feature. However, the small bowel is the final frontier of endoscopic evaluation; therefore, small bowel involvement is considered a significant medical challenge in the diagnosis and treatment of patients with CD. Endoscopic visualization and biopsy sampling of the small bowel are crucial for accurate diagnosis, effective monitoring, and management of complications of CD. Small bowel endoscopy enables the early detection of mucosal lesions, facilitates timely intervention for complications such as strictures or bleeding, and plays a critical role in reducing the need for surgical resection. Moreover, it enables targeted tissue acquisition and objective assessment of disease activity, both of which are crucial for optimal treatment planning and monitoring of therapeutic responses. Given these clinical advantages, small bowel endoscopy has become an indispensable tool in the comprehensive management of CD. This review summarizes the current role and evolving advances in small bowel endoscopy, with particular emphasis on its therapeutic applications—including enteroscopic balloon dilation, endoscopic hemostasis, and foreign body retrieval—and discusses future directions based on recent evidence and expert guidelines.

3,395 View
255 Download

Original Articles

Double-balloon is equal to motorized spiral enteroscopy in a German prospective, randomized trial: Mate Knabe, Myriam Heilani, Jens Wetzka, Lukas Welsch, Georg Dultz, Insa Aschmoneit-Messer, Eva Herrmann, Stefan Zeuzem, Andrea May; Clin Endosc 2025;58(4):569-576. Published online July 7, 2025; DOI: https://doi.org/10.5946/ce.2024.308

Graphical Abstract Abstract PDF

Background
/Aims: Deep enteroscopy is a challenging and time-consuming procedure. Two devices have become the clinical standards for patients: double-balloon enteroscopy (DBE) and motorized spiral enteroscopy (mSPE). Initially, mSPE demonstrated impressive results, with high rates of total enteroscopy, which were superior to those of all other devices. However, for safety reasons, mSPE was withdrawn from the market, and it remains uncertain whether it will return after technical improvements. This prospective randomized trial aimed to compare the DBE and mSPE.
Methods
Patients indicated for enteroscopy were randomized to undergo either mSPE or DBE. The time to diagnosis or complete enteroscopy was measured, and all complications were recorded.
Results
A total of 48 enteroscopic procedures were performed, including 23 mSPE and 25 DBE. No significant difference was noted in the procedure time (p=0.212). The mSPE group exhibited a shorter mean procedure time of 54 (range, 15–114; standard deviation [SD], 26) minutes, whereas the DBE group had a mean procedure time of 63 (range, 20–131; SD, 25) minutes. One perforation was seen in the mSPE group.
Conclusions
DBE and mSPE are both effective enteroscopy methods but showed no significant difference in this randomized trial (German trial registry: DRKS 00025890).

Citations

Citations to this article as recorded by

Spirals and balloons: a new chapter in deep enteroscopy?
Seung Min Hong, Dong Hoon Baek
Clinical Endoscopy.2025; 58(4): 546. CrossRef

4,135 View
73 Download
1 Web of Science
1 Crossref

Risk factors for recurrent stenosis after balloon dilation for benign hepaticojejunostomy anastomotic stricture: Takafumi Mie, Takashi Sasaki, Takeshi Okamoto, Tsuyoshi Takeda, Chinatsu Mori, Yuto Yamada, Takaaki Furukawa, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira; Clin Endosc 2024;57(2):253-262. Published online May 16, 2023; DOI: https://doi.org/10.5946/ce.2022.216

Graphical Abstract Abstract PDF

Background
/Aims: Hepaticojejunostomy anastomotic stricture (HJAS) is a feared adverse event associated with hepatopancreatobiliary surgery. Although balloon dilation for benign HJAS during endoscopic retrograde cholangiopancreatography with balloon-assisted enteroscopy has been reported to be useful, the treatment strategy remains controversial. Therefore, we evaluated the outcomes and risk factors of recurrent stenosis after balloon dilation alone for benign HJAS.
Methods
We retrospectively analyzed consecutive patients who underwent balloon-assisted enteroscopy–endoscopic retrograde cholangiopancreatography for benign HJAS at our institution between July 2014 and December 2020.
Results
Forty-six patients were included, 16 of whom had recurrent HJAS after balloon dilation. The patency rates at 1 and 2 years after balloon dilation were 76.8% and 64.2%, respectively. Presence of a residual balloon notch during balloon dilation was an independent predictor of recurrence (hazard ratio, 2.80; 95% confidence interval, 1.01–7.78; p=0.048), whereas HJAS within postoperative 1 year tended to be associated with recurrence (hazard ratio, 2.43; 95% confidence interval, 0.85–6.89; p=0.096). The patency rates in patients without a residual balloon notch were 82.1% and 73.1% after 1 and 2 years, respectively.
Conclusions
Balloon dilation alone may be a viable option for patients with benign HJAS without residual balloon notches on fluoroscopy.

Citations

Citations to this article as recorded by

Efficacy and Safety of a 6‐Month Placement of a Fully Covered Self‐Expanding Metal Stent for Refractory or Recurrent Hepaticojejunostomy Anastomotic Stricture via Balloon Enteroscopy‐Assisted Endoscopic Retrograde Cholangiopancreatography
Taro Hanaoka, Kosuke Okuwaki, Masafumi Watanabe, Tomohisa Iwai, Kai Adachi, Akihiro Tamaki, Junro Ishizaki, Yusaku Manabe, Masayoshi Tadehara, Rikiya Hasegawa, Takaaki Matsumoto, Hiroshi Imaizumi, Mitsuhiro Kida, Chika Kusano
DEN Open.2026;[Epub] CrossRef
Successful treatment of a complete obstruction at the hepaticojejunostomy anastomosis using cholangioscopic biopsy forceps inserted via the endoscopic ultrasound-guided hepaticogastrostomy route
Sho Hasegawa, Kunihiro Hosono, Masato Yoneda
Clinical Endoscopy.2026; 59(2): 311. CrossRef
Endoscopic Management of Pancreatobiliary Diseases in Patients with Surgically Altered Anatomy: A Perspective from Single-Balloon Enteroscopy
Yuki Tanisaka, Shomei Ryozawa, Masafumi Mizuide, Akashi Fujita, Suguru Ito, Ryuichi Watanabe, Ryosuke Hamamura, Yoshiki Matsuno
Digestion.2026; : 1. CrossRef
Innovation in the percutaneous management of benign hepaticojejunostomy stricture with multiple lithiasis using SpyGlass Discover and biodegradable stent: a case report
Edison Santiago Borja Villacrés, Jefferson Andrés Carvajal Torres, Santiago Andrés Muñoz-Palomeque
Journal of Surgical Case Reports.2025;[Epub] CrossRef

7,824 View
226 Download
5 Web of Science
4 Crossref

Reviews

A practical approach for small bowel bleeding: Sung Eun Kim, Hyun Jin Kim, Myeongseok Koh, Min Cheol Kim, Joon Sung Kim, Ji Hyung Nam, Young Kwan Cho, A Reum Choe, The Research Group for Capsule Endoscopy and Enteroscopy of the Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2023;56(3):283-289. Published online May 11, 2023; DOI: https://doi.org/10.5946/ce.2022.302

Search