Balloon enteroscopy versus spiral enteroscopy for small-bowel disorders: a systematic review and meta-analysis. Baniya R, Upadhya S, Subedi SC, Khan J, Sharma 3, Mohammed T2, Bachuwa G, Jamil LH. Gastrointest Endosc. 2017 Jun 23. [Epub ahead of print]

BACKGROUND AND AIMS:Two novel enteroscopic procedures, balloon enteroscopy (BE) and spiral enteroscopy (SE), have revolutionized the diagnostic and therapeutic approach to small-bowel disorders. These disorders that historically required surgical interventions are now investigated and managed nonsurgically. There are only a few weakly powered studies comparing the outcomes of SE and BE.

We conducted a systematic review and meta-analysis to compare the efficacy and safety of these 2 procedures.METHODS:PubMed, Cochrane library, Scopus and databases were searched for all studies published up to January 12, 2017 comparing the efficacy and safety of balloon enteroscopy (single or double) and spiral enteroscopy. Primary outcomes of interest were diagnostic and therapeutic success rates. Other outcomes included procedure length, depth of maximal insertion (DMI), rate of complete enteroscopy, and adverse events. Odds ratios (OR) were calculated for categorical variables, and mean differences (MD) were calculated for continuous variables. Mentel-Haenszel method was used to analyze the data. Fixed and random effect models were used for <50% heterogeneity and more than >50% heterogeneity, respectively.RESULTS:A total of 8 studies met the inclusion criteria for this meta-analysis. A total of 615 procedures were analyzed, which included 394 balloon enteroscopy and 221 spiral enteroscopy procedures. There were no significant differences in diagnostic and therapeutic success rates (OR, 1.27; 95% confidence interval (CI), 0.86 - 1.88; p= .22 and OR, 1.23; 95% CI, 0.82 - 1.84, p= .32, respectively) between the 2 procedures. Similarly, DMI was not significantly different between the 2 groups (MD, 26.29; 95% CI, 20.92 - 73.49; P = .28). However, the procedure time was significantly less for the SE group compared with BE (MD, 11.26; 95% CI, 2.72 - 19.79; P = .010). A subgroup analysis comparing double-balloon enterosocpy to spiral enteroscopy yielded similar results.CONCLUSIONS:Both procedures achieve similar diagnostic and therapeutic outcomes and with similar depth of insertion. SE has the benefit of shorter procedural time.

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