Clinical Endoscopy

Recent technological advances in device-assisted enteroscopy: Mi Rae Lee, Jin Su Kim; Received April 30, 2025 Accepted June 9, 2025 Published online March 3, 2026; DOI: https://doi.org/10.5946/ce.2025.136 [Epub ahead of print]

Abstract PDF PubReader ePub: 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 Despite promising early results, PSE has been withdrawn from the market owing to safety concerns, particularly esophageal injuries.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.

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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 PubReader ePub: 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.

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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 PubReader ePub

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).

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

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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

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