Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2016; 22(40): 8999-9011
Published online Oct 28, 2016. doi: 10.3748/wjg.v22.i40.8999
Systematic review: Safety of balloon assisted enteroscopy in Crohn’s disease
Ahilan Arulanandan, Parambir S Dulai, Siddharth Singh, William J Sandborn, Denise Kalmaz
Ahilan Arulanandan, Parambir S Dulai, Siddharth Singh, William J Sandborn, Denise Kalmaz, Division of Gastroenterology, University of California San Diego, La Jolla, CA 92037, United States
Author contributions: Arulanandan A and Dulai PS acquired the data; Arulanandan A, Dulai PS and Singh S analyzed data, interpreted data, and drafted the manuscript; Arulanandan A, Dulai PS and Kalmaz D created the study and design; Dulai PS, Singh S, Sandborn WJ and Kalmaz D made critical revisions to manuscript and supervised study.
Supported by Training Grant Through the National Institute of Diabetes and Digestive and Kidney Diseases, No. 5T32DK007202 to Dulai PS.
Conflict-of-interest statement: All authors have no relevant conflicts of interest.
Data sharing statement: There are no additional data.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ahilan Arulanandan, MD, Division of Gastroenterology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92037, United States. ahilanarul@gmail.com
Telephone: +1-858-6575278 Fax: +1-858-6575022
Received: May 18, 2016
Peer-review started: May 18, 2016
First decision: June 20, 2016
Revised: July 1, 2016
Accepted: August 1, 2016
Article in press: August 1, 2016
Published online: October 28, 2016
Processing time: 161 Days and 5.6 Hours
Abstract
AIM

To determine the overall and comparative risk of procedure related perforation of balloon assisted enteroscopy (BAE) in Crohn’s disease (CD).

METHODS

Systematic review (PROSPERO #CRD42015016381) of studies reporting on CD patients undergoing BAE. Seventy-three studies reporting on 1812 patients undergoing 2340 BAEs were included. Primary outcome of interest was the overall and comparative risk of procedure related perforation of diagnostic BAE in CD. Secondary outcomes of interest were risk of procedure related perforation of diagnostic double balloon enteroscopy (DBE), risk of procedure related perforation of therapeutic BAE, efficacy of stricture dilation, and clinical utility of endoscopically assessing small bowel disease activity.

RESULTS

Per procedure perforation rate of diagnostic BAE in CD was 0.15% (95%CI: 0.05-0.45), which was similar to diagnostic BAE for all indications (0.11%; IRR = 1.41, 95%CI: 0.28-4.50). Per procedure perforation rate of diagnostic DBE in CD was 0.12% (95%CI: 0.03-0.44), which was similar to diagnostic DBE for all indications (0.22%; IRR = 0.54, 95%CI: 0.06-0.24). Per procedure perforation rate of therapeutic BAE in CD was 1.74% (95%CI: 0.85-3.55). Eighty-six percent of therapeutic perforations were secondary to stricture dilation. Dilation was attempted in 207 patients and 30% required surgery during median follow-up of 18 months. When diagnostic BAE assessed small bowel disease activity, changes in medical therapy resulted in endoscopic improvement in 77% of patients.

CONCLUSION

Diagnostic BAE in CD has a similar rate of perforation as diagnostic BAE for all indications and can be safely performed in assessment of mucosal healing.

Keywords: Crohn’s disease; Balloon; Enteroscopy; Safety; Perforation; Stricture

Core tip: Crohn’s disease (CD) affects the small bowel in up to 60% of patients, but evaluation of small bowel disease is often difficult. Balloon assisted enteroscopy (BAE) can evaluate the small bowel but its safety and diagnostic utility is not established. This systematic review includes 73 studies reporting on 1812 patients undergoing 2340 procedures to evaluate its safety and possible utility. We found that diagnostic BAE in CD had a similar rate of perforation as diagnostic BAE for all indications, suggesting BAE is a safe method for small bowel evaluation in CD.