Clinical Endoscopy

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.

3,374 View
193 Download

Original Article

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

4,085 View
73 Download
1 Web of Science
1 Crossref

Review

Recent developments in small bowel endoscopy: the “black box” is now open!: Luigina Vanessa Alemanni, Stefano Fabbri, Emanuele Rondonotti, Alessandro Mussetto; Clin Endosc 2022;55(4):473-479. Published online July 14, 2022; DOI: https://doi.org/10.5946/ce.2022.113

Abstract PDF

Over the last few years, capsule endoscopy has been established as a fundamental device in the practicing gastroenterologist’s toolbox. Its utilization in diagnostic algorithms for suspected small bowel bleeding, Crohn’s disease, and small bowel tumors has been approved by several guidelines. The advent of double-balloon enteroscopy has significantly increased the therapeutic possibilities and release of multiple devices (single-balloon enteroscopy and spiral enteroscopy) aimed at improving the performance of small bowel enteroscopy. Recently, some important innovations have appeared in the small bowel endoscopy scene, providing further improvement to its evolution. Artificial intelligence in capsule endoscopy should increase diagnostic accuracy and reading efficiency, and the introduction of motorized spiral enteroscopy into clinical practice could also improve the therapeutic yield. This review focuses on the most recent studies on artificial-intelligence-assisted capsule endoscopy and motorized spiral enteroscopy.

Citations

Citations to this article as recorded by

Do all antithrombotic agents have a similar impact on small bowel bleeding?
Chung Hyun Tae, Ki-Nam Shim
Clinical Endoscopy.2025; 58(1): 80. CrossRef
Balloon-assisted enteroscopy in the management of adult small-bowel intussusception: a comparative analysis of with and without double-balloon enteroscopy
Won Shik Kim, Beom Jae Lee, Moon Kyung Joo, Seung Han Kim, Jong-Jae Park
Surgical Endoscopy.2025; 39(3): 2044. CrossRef
Panenteric capsule endoscopy in gastrointestinal bleeding – time to change old habits?
Francesco Segatta, Silvia Paggi, Franco Radaelli, Emanuele Rondonotti
Current Opinion in Gastroenterology.2025; 41(3): 139. CrossRef
Small Bowel Tumors: A 7-Year Study in a Tertiary Care Hospital
Sergiu Marian Cazacu, Dan Cârțu, Mihai Popescu, Liliana Streba, Bogdan Silviu Ungureanu, Vlad Florin Iovănescu, Mihai Cimpoeru, Cecil Sorin Mirea, Valeriu Marian Surlin, Stelian Mogoantă, Mirela Marinela Florescu
Cancers.2025; 17(9): 1465. CrossRef
Spirals and balloons: a new chapter in deep enteroscopy?
Seung Min Hong, Dong Hoon Baek
Clinical Endoscopy.2025; 58(4): 546. CrossRef
Deep learning–based lesion detection and severity grading of small-bowel Crohn’s disease ulcers on double-balloon endoscopy images
Wanqing Xie, Jing Hu, Pengcheng Liang, Qiao Mei, Aodi Wang, Qiuyuan Liu, Xiaofeng Liu, Juan Wu, Xiaodong Yang, Nannan Zhu, Bingqing Bai, Yiqing Mei, Zhen Liang, Wei Han, Mingmei Cheng
Gastrointestinal Endoscopy.2024; 99(5): 767. CrossRef
Capsule Endoscopy for the Diagnosis of Suspected Small Bowel Bleeding
P. P. Polyakov, A. Ya. Alimetov, A. V. Onopriev, A. V. Avakimyan, A. Kh. Kade, S. A. Zanin, E. S. Zanina, Z. S. Popov, A. I. Trofimenko, Z. T. Jndoyan, A. A. Avagimyan
Innovative Medicine of Kuban.2023; (3): 121. CrossRef
Outcomes of Double Balloon-Enteroscopy in Elderly vs. Adult Patients: A Retrospective 16-Year Single-Centre Study
Margherita Trebbi, Cesare Casadei, Silvia Dari, Andrea Buzzi, Mario Brancaccio, Valentina Feletti, Alessandro Mussetto
Diagnostics.2023; 13(6): 1112. CrossRef

8,218 View
310 Download
7 Web of Science
8 Crossref

Special Issue Article of IDEN 2013

Deep Enteroscopy: Which Technique Will Survive?: Seong Ran Jeon, Jin-Oh Kim; Clin Endosc 2013;46(5):480-485. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.480

Abstract PDF

The advent of deep enteroscopy (DE) has dramatically changed diagnostic and therapeutic approaches to small bowel diseases. Unlike capsule endoscopy, which is unable to obtain biopsies or treat a disease, DE techniques have diagnostic and therapeutic capabilities. Double-balloon enteroscopy (DBE) was introduced in 2001, and single-balloon enteroscopy (SBE) and spiral enteroscopy (SE) were subsequently developed for small bowel investigation. In published reports comparing these different enteroscopy techniques, most comparative parameters (depth of insertion, complications, learning curve, diagnostic yield, and therapeutic yield) were comparable among DBE, SBE, and SE. However, the procedure duration appears to be shorter for SE than for DBE and SBE. The rate of complete enteroscopy is clearly superior for DBE, compared with SE and SBE. Because these results do not indicate an increase in diagnostic or therapeutic yield, the clinical impact of complete enteroscopy remains controversial. According to previous studies, the three DE methods seem to be equally effective and safe in the clinical setting. Although larger randomized controlled trials are needed to evaluate the procedural characteristics and clinical impact, the selection of an enteroscopic technique should be based on availability and the endoscopist's experience.

Citations

Citations to this article as recorded by

Comparative efficacy and safety of nalbuphine and hydromorphone in painless colonoscopy techniques: a randomized controlled trial
Chunliu Hou, Siming Zhang, Yuqing Zhu, Guochun Wen, Guoran Wang, Jinxiang Dai, Fei Xu, Chunjie Li, Huiyi Chen, Di Wang, Qingqing Han, Xuesen Su, Wenjie Zhang, Shouyuan Tian, Yan Li
BMC Anesthesiology.2025;[Epub] CrossRef
Endoscopic submucosal dissection versus endoscopic mucosal resection for early esophageal neoplasia: A systematic review and meta-analysis
Hur Abbas, Maria Murtaza, Khadija Azeem, Maryam Asad, Maham Shakeel, Irtaza Hassan, Manail Asif, Haya Kashif, Lia Anwar, Maham Abid, Hasan Anwar, Hassan Ali, Satesh Kumar, Mahima Khatri
Laparoscopic, Endoscopic and Robotic Surgery.2025; 8(4): 191. CrossRef
Use of Device-Assisted Enteroscopy in Small Bowel Disease: An Expert Consensus Statement by the Korean Association for the Study of Intestinal Diseases
Han Hee Lee, Jin Su Kim, Hyeon Jeong Goong, Shin Hee Lee, Eun Hye Oh, Jihye Park, Min Cheol Kim, Kwangwoo Nam, Young Joo Yang, Tae Jun Kim, Seung-Joo Nam, Hee Seok Moon, Jae Hyun Kim, Duk Hwan Kim, Seong-Eun Kim, Seong Ran Jeon, Seung-Jae Myung
The Korean Journal of Gastroenterology.2023; 81(1): 1. CrossRef
Three cases of jejunal tumors detected by standard upper gastrointestinal endoscopy: A case series
Jaesun Lee, Sunmoon Kim, Daesung Kim, Sangeok Lee, Kihyun Ryu
World Journal of Clinical Cases.2023; 11(4): 962. CrossRef
Use of device-assisted enteroscopy in small bowel disease: an expert consensus statement by the Korean Association for the Study of Intestinal Diseases
Han Hee Lee, Jin Su Kim, Hyeon Jeong Goong, Shin Hee Lee, Eun Hye Oh, Jihye Park, Min Cheol Kim, Kwangwoo Nam, Young Joo Yang, Tae Jun Kim, Seung-Joo Nam, Hee Seok Moon, Jae Hyun Kim, Duk Hwan Kim, Seong-Eun Kim, Seong Ran Jeon, Seung-Jae Myung
Intestinal Research.2023; 21(1): 3. CrossRef
Achieving Total Enteroscopy by Consecutive Bidirectional Double-balloon Enteroscopy Procedures
Liang Zhao, An-ning Yin, Fei Liao, Yi-juan Ding, Hong-gang Yu
Current Medical Science.2022; 42(1): 144. CrossRef
Enteroscopia de doble balón: experiencia inicial en un hospital universitario
Arecio Peñaloza Ramírez, Jonathan Barreto Pérez, Fabio Sierra Matamoros, Esteban Coral Argoty, María Alejandra Castro Rodríguez, Pedro Nel Aponte Ordoñez
Revista colombiana de Gastroenterología.2021; 36(3): 327. CrossRef
Device-assisted enteroscopy training. A rapid review
Federico Soria Gálvez, Octavio López-Albors, Pilar Esteban Delgado, Enrique Pérez-Cuadrado Robles, Rafael Latorre Reviriego
Revista Española de Enfermedades Digestivas.2020;[Epub] CrossRef
Complete anterograde small-bowel exploration with the novel motorized spiral enteroscope
Begoña González-Suárez, Antonio Giordano, Miriam Escapa, Josep Llach
VideoGIE.2020; 5(11): 517. CrossRef
Small bowel bleeding
Stefania Chetcuti Zammit, Reena Sidhu
Current Opinion in Gastroenterology.2018; 34(3): 165. CrossRef
Paradigm shift: should the elderly undergo propofol sedation for DBE? A prospective cohort study
Hey-Long Ching, Federica Branchi, David S Sanders, David Turnbull, Reena Sidhu
Frontline Gastroenterology.2018; 9(3): 192. CrossRef
ANALYSIS OF DOUBLE BALLOON ENTEROSCOPY: INDICATIONS, FINDINGS, THERAPEUTIC AND COMPLICATIONS
Flávio Heuta IVANO, Izabela Rodrigues VILLELA, Lívia Fouani de MIRANDA, Thaísa Sami NAKADOMARI
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo).2017; 30(2): 83. CrossRef
Endoscopy in the Diagnosis and Management of Complications of Inflammatory Bowel Disease
Benjamin Tharian, Nayana George, Udayakumar Navaneethan
Inflammatory Bowel Diseases.2016; 22(5): 1184. CrossRef
Comparison of double-balloon and single-balloon enteroscope for therapeutic endoscopic retrograde cholangiography after Roux-en-Y small bowel surgery
Michael De Koning, Tom G. Moreels
BMC Gastroenterology.2016;[Epub] CrossRef
Enteroscopy
Shailendra S. Chauhan, Michael A. Manfredi, Barham K. Abu Dayyeh, Brintha K. Enestvedt, Larissa L. Fujii-Lau, Sri Komanduri, Vani Konda, John T. Maple, Faris M. Murad, Rahul Pannala, Nirav C. Thosani, Subhas Banerjee
Gastrointestinal Endoscopy.2015; 82(6): 975. CrossRef
Deep enteroscopy with a conventional colonoscope: initial multicenter study by using a through-the-scope balloon catheter system
Rabia Ali, Daniel Wild, Frederick Shieh, David L. Diehl, Monika Fischer, Wataru Tamura, David T. Rubin, Vivek Kumbhari, Patrick Okolo, Andrew Storm, Zamir Halpern, Helmut Neumann, Harshit S. Khara, Mark B. Pochapin, Seth A. Gross
Gastrointestinal Endoscopy.2015; 82(5): 855. CrossRef
Small bowel intervention and application of enteroscopy for altered small bowel anatomy—endoscopic advanced therapy using double balloon enteroscopy
Masaaki Shimatani, Norimasa Fukata, Ryo Suzuki, Sachi Miyamoto, Kota Kato, Toshiyuki Mitsuyama, Hideaki Miyoshi, Tsukasa Ikeura, Makoto Takaoka, Kazuichi Okazaki
Gastrointestinal Intervention.2014; 3(2): 69. CrossRef
Palliative enteroscopic stent placement for malignant mid-gut obstruction
Esha Baichoo, Louis M. Wong Kee Song
Gastrointestinal Intervention.2014; 3(1): 30. CrossRef

11,186 View
93 Download
18 Crossref

First
Prev
Page of 1
Next
Last

Search