Single-balloon and spiral enteroscopy may have similar diagnostic and therapeutic yields to double-balloon enteroscopy: Results from a meta-analysis of randomized controlled trials and prospective studies

BACKGROUND Double-balloon, single-balloon, and spiral enteroscopy(DBE, SBE, and SE) have revolutionized the management of intestinal diseases. However, evidence about efficacies of these methods is lacking. We aimed to conduct a meta-analysis comparing the clinical outcomes among DBE, SBE, and SE.METHODS We searched randomized controlled trials and prospective studies in MEDLINE,Pub Med, EMBASE, Cochrane Library, and Chinese CQVIP database. Studies referencing the comparison of at least two of these three methods were included.Primary outcome was diagnostic yield. Other outcomes were therapeutic yield,total enteroscopy, examination time, time to maximum insertion, and depth of maximal insertion(DMI).RESULTS Eleven studies including 727 patients were identified: DBE vs SE(n = 6), DBE vs SBE(n = 4), and SBE vs SE(n = 1). The diagnostic and therapeutic yields did not differ significantly when comparing DBE with SE [odds ratio(OR) = 1.19, 95%confidence interval(CI): 0.68-2.08; OR = 1.17, 95%CI: 0.61-2.23] and DBE with SBE (OR = 0.85, 95%CI: 0.55-1.33; OR = 1.71, 95%CI: 0.64-4.60). Total enteroscopy,examination time, time to maximum insertion, and DMI were similar between SBE and DBE. DBE was superior to SE with regard to DMI [mean difference(MD)= 36.76, 95%CI: 5.09-68.43], with longer time to maximum insertion(MD = 15.14,95%CI: 12-18.27) and examination time(MD = 12.98, 95%CI: 9.57-16.38).CONCLUSION DBE and SBE have similar clinical outcomes. Compared with DBE, SE seems to have similar diagnostic and therapeutic yields, but shorter procedural time in cost of less depth of insertion. SE needs further evaluation vs SBE. DBE is recommended for complete enteroscopy.